Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID-19: A Single-Center Experience

Abstract

Objective Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome associated with multiorgan damage that occurs following coronavirus disease 2019 (COVID-19). Research on clinical and laboratory findings, and imaging studies, aiming to predict the progression to severe disease state is limited. This study recruited patients with MIS-C who presented with mild or severe symptoms from a single center in Turkey and evaluated factors related to their symptoms. Methods This retrospective study included 25 pediatric patients with mild and severe presentations of MIS-C. We explored the differences in demographic and clinical data on clinical severity to understand their possible diagnostic and prognostic values. Results Patients with MIS-C had cardiovascular symptoms (68%), gastrointestinal symptoms (64%), dermatologic/mucocutaneous findings (64%), lung involvement (36%), and neurological symptoms (16.0%). About 45.1% of patients with MIS-C had manifestations that overlapped with Kawasaki disease. Eleven patients (44%) were admitted to the intensive care unit, and one (4%) patient died. Grouping based on clinical severity did not differ statistically in terms of gender, age, height, weight, body mass index, and duration of hospital stay. Procalcitonin and ferritin levels correlated with disease severity. The receiver operating characteristic curve for D-dimer gave the highest value of area under the curve, among other biomarkers. The cutoff value for D-dimer was determined as more than 6780. Conclusions Although COVID-19 is usually mild in children, some can be severely affected, and clinical severity in MIS-C can differ from mild to severe multisystem involvement. This study shows that procalcitonin, ferritin, and D-dimer levels may give us information about disease severity.

Comparison of Characteristics and Outcomes of Multisystem Inflammatory Syndrome and Prepandemic Kawasaki's Disease

“…In terms of laboratory findings, lymphopenia, thrombocytopenia, and hyponatremia are mostly expected in MIS-C and they are more prominent compared with the KD. 3,18,19,22 In our study, consistent with the literature, the mean serum sodium level was considerably lower in the MIS-C group than in the KD group. Although there was no statistically significant difference between the groups for lymphopenia, it was more frequent in the MIS-C group.…”

“…17 In our study, the sedimentation rate was higher in the KD group than in the MIS-C group, which was consistent with the literature. It has been reported that the levels of fibrinogen, procalcitonin, D-dimer, and ferritin were increased in MIS-C. 5,22 We obtained similar results in our MIS-C group. These differences in the clinical and laboratory findings suggest that MIS-C and KD are two different diseases with overlapping clinical features and both diseases have different immunologic phenotypes.…”

“…4,14,25 Although cardiac complications occur in both diseases, myocardial dysfunction and valvular involvement are more common in MIS-C and coronary artery involvement is more common in KD. 3,18,22 In addition, shock may occur in MIS-C, requiring pediatric intensive care monitoring. 19 In our study, seven pediatric patients in the MIS-C group and only one patient in the KD group required intensive care monitoring due to the severity of the disease.…”

Clinical and Laboratory Evaluations of Patients Diagnosed as Having Multisystem Inflammatory Syndrome Associated with Coronavirus Disease 2019 in Children: A Single Center Experience from Konya

“…7 Clinically, persistent fever, increased proinflammatory cytokines, and exaggerated response in inflammatory markers (CRP, ESH, D-dimer, ferritin) have been detected, resulting in multiorgan dysfunction. 1 8 In the present study, we compared the characteristics of patients with MIS-C according to disease severity and observed that the most common clinical severity of MIS-C was moderate (47%). The most common clinical symptom was fever, and the other common clinical findings were nonpurulent conjunctivitis, rashes, fatigue, and strawberry tongue.…”

“…Even though COVID-19 is usually mild in children, the clinical severity of MIS-C varies according to the organ system that is involved. 1 According to CDC data, the total number of MIS-C cases seen in the United States until August 29, 2022 was reported as 8,862 and the number of MIS-C-related deaths as 72. 2 Patients with MIS-C have various symptoms ranging from fever to cardiogenic shock.…”