Abstract
Aim: Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey.
Methods: The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients’ medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis.
Results: The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6-9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112-228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30-84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58-20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died.
Conclusion: The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.
Keywords: COVID-19; Kawasaki disease; MIS-C; child; shock.
【저자키워드】 COVID-19, MIS-C, Child, Kawasaki disease, Shock., 【초록키워드】 Treatment, SARS-CoV-2, Intravenous immunoglobulin, intensive care, fatigue, children, hospital, Diagnosis, Gender, C-reactive protein, Turkey, outcome, glucocorticoid, Clinical features, Retrospective study, Shock, body mass index, PCR, clinical, management, Fever, immunomodulatory, Patient, death, laboratory characteristics, age, Admission, patients, differential diagnosis, Analysis, Inflammatory, medical record, interquartile range, erythrocyte sedimentation rate, procalcitonin level, clinician, median age, multivariate logistic regression, syndrome, positive, positive serology, Gastrointestinal symptom, polymerase chain, classical, collected, died, healthy, diagnosed, required, elevated, Most patient, conducted, median, treated, groups, predominant, IQR, 【제목키워드】 children, Turkey, Inflammatory, syndrome, with COVID-19,