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.
Keywords: Coronary artery outcomes; MIS-C; MIS-C and Kawasaki disease; SARS-CoV-2.
【저자키워드】 SARS-CoV-2, MIS-C, Coronary artery outcomes, MIS-C and Kawasaki disease, 【초록키워드】 COVID-19, coronavirus disease, SARS-CoV-2, Arthritis, Intravenous immunoglobulin, mechanical ventilation, children, Comorbidity, ferritin, outcome, immunomodulatory drugs, Shock, Patient, Prognostic marker, laboratory characteristics, Follow-up, Rash, hemodynamic, Inflammatory, Hospital stay, Coronary artery, World Health Organization, Non-survivors, subject, syndrome, skin rash, serum ferritin level, MOST, survivor, FIVE, laboratory parameter, non-survivor, statistical, enrolled, analyzed, required, median, significantly higher, not affect, children with MIS-C, preexisting comorbidity, respiratory manifestation, 【제목키워드】 children, Inflammatory, syndrome,