Outcomes of multisystem inflammatory syndrome in children temporally related to COVID-19: a longitudinal study

Abstract

To study the clinical, laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to coronavirus disease 2019 (COVID-19) in a resource-limited setting. All children meeting the World Health Organization case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4–6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the stata-12 software. Thirty-one children with MIS-C were enrolled in an 11-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding; gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight percent of children presented with shock, and 22.5% required mechanical ventilation. HSP like rash, gangrene and arthritis were uncommon clinical observations.The median duration of hospital stay was 9 (6.5–18.5) days: four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in non-survivors as compared to survivors [1061 (581, 2750) vs 309.5 (140, 720.08), p value = 0.045]. Six patients had coronary artery involvement; five recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome. Most children with MIS-C present with acute hemodynamic and respiratory symptoms.The outcome is favorable in children without preexisting comorbidities.Raised ferritin level may be a poor prognostic marker. The coronary outcomes at follow-up were reassuring. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-05030-y.

Eastern India Collaboration on Multisystem Inflammatory Syndrome in Children (EICOMISC): A Multicenter Observational Study of 134 Cases

“…This is in agreement with the epidemiology of MIS-C, which indicates that majority of the cases develop 4–6 weeks after exposure to the virus ( 27 ). In our study, 23.9% had underlying co-morbidities, whereas it was 38.7% in the previous Indian study ( 13 ), 28.35% in Turkish study ( 26 ), and 15.8% in the Latin American study ( 24 ).…”

“…In our study, rash was reported in 40% cases compared to 57.14% in the previous Indian study ( 12 ), 68% in the Brazilian study ( 25 ), and 54.9% in a systemic review ( 12 ). Our study reported a higher rate of non-purulent conjunctivitis (71%) compared to 25.8% in the Indian study ( 13 ), 31.3% in the Turkish study ( 26 ), and 49.8% reported in the systematic review ( 12 ).…”

“…In our cohort, the median age of the children was 7 years in survivors compared to 11 years who died. In the above study from India, the corresponding figures were 8 years and 10.8 years, respectively ( 13 ). Majority of children who died were male (83.3%), which was higher than that (72.3%) reported in a systematic review ( 12 ).…”

“…In a recent systematic review analyzing the data of 953 cases from 68 article, the median age was 8 years with males accounting for 58.9% of the cases ( 12 ). In a largest single center study from India, the median age was 8 years with males constituting 61.29% of the cohort ( 13 ). In a multi-national study from Latin America (low-and middle-income country setting like India), the median age was 7 years with 54.7% being male ( 24 ).…”

“…Few single center studies from resource-poor settings have reported about the epidemiology, clinical feature and outcome of MIS-C. However, there is a scarcity of large multi-center data on the same including that from Indian setting ( 13 , 17 , 18 ). Moreover, as COVID-19 has become endemic in most parts of the world, MIS-C cases will occur sporadically posing challenges in the management.…”