1. Presentation with shock in the setting of multisystem inflammatory syndrome in children (MIS-C) was associated with worse outcomes
2. Shorter duration of MIS-C symptoms prior to hospital admission was associated with poor outcomes
Evidence Rating Level: 2 (Good)
Study Rundown: MIS-C is a complication of SARS-CoV-2 that has led to severe illness in children worldwide, often resulting in shock and multi-organ failure. Despite broad reporting of MIS-C, there has yet to be an international study of this entity. This international cohort of children describes the presentation and clinical course of MIS-C, and identifies clinical and biological predictors of severe disease. Around 40% of patients with MIS-C presented with shock requiring intensive care. Shock was associated with worse outcomes including ECMO and death, especially when the time interval between symptom onset and hospital admission was shorter. Shock was also associated with black race, lower platelet count, and higher inflammatory markers. Data from this large and diverse study can help inform future management of these patients as the pandemic evolves.
Relevant Reading: Multi-system Inflammatory Syndrome in US children and adolescents
In-Depth [retrospective cohort]: 183 patients from over 30 hospitals in 13 different countries were included in the study. All 183 patients presented with fever and 63.9% presented with gastrointestinal symptoms. 62.3% had evidence of current or recent SARS-CoV-2 infection. Patients were separated into three separate groups depending on their presentation; Kawasaki-like disease (KD) (14.8%), incomplete KD (42.6%), and shock (42.6%). Patients who presented with shock were more likely to be older (9.2 vs 3.8 years in KD-like group and 5.9 in the incomplete KD-like group, p<0.001). Shock was also associated with black race, higher rates of gastrointestinal, cardiorespiratory, and neurological symptoms, significantly lower platelet count, and higher inflammatory markers than the other two groups. These patients also developed more cardiac complications. Patients with KD-like illness required less intensive care and had shorter hospital stays (7.3 days vs. 8.1 in incomplete KD-like, and 9.5 in the shock group, p<0.001) Patients with incomplete KD-like illness were more likely to have better outcomes. A shorter duration of symptoms prior to admission was associated with worse clinical outcomes including death and ECMO requirement. Three patients in the cohort died.
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