Clinical manifestations and outcomes associated with PICU admission in children with multisystem inflammatory syndrome in Taiwan: A retrospective cohort study

Abstract

BackgroundMultisystem inflammatory syndrome in children (MIS‐C) is a rare and serious systemic inflammatory disorder that occurs following a severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. This study aims to investigate the clinical manifestations, risk factors associated with pediatric intensive care unit (PICU) admission, and outcome among children with MIS‐C in Taiwan.MethodsA retrospective analysis was conducted among pediatric patients diagnosed with MIS‐C between June 2022 and February 2023 at Chang Gung Memorial Hospital, Linkou, Taiwan. Data on demographics, clinical features, laboratory findings, treatment modalities, and outcomes were collected and analyzed.ResultsTwenty‐eight MIS‐C patients, including 9 boys and 19 girls, with an average age of 5.3 ± 3.8 years old, were enrolled. Most of the cases (78.6%) were diagnosed following the first pandemic wave of COVID‐19 in Taiwan. The leading clinical manifestations observed were fever (100%), skin rash (64.3%), tachycardia (46.4%), and vomiting (46.4%). Nine patients (32.1%) were admitted to the PICU due to hypotension or neurological manifestations. Higher levels of band‐form white blood cells, procalcitonin, ferritin, d‐dimer, prothrombin time, NT‐proBNP, and lower platelet levels on arrival were associated with PICU admission (p = 3.9 × 10−2,9 × 10−3, 4 × 10−3,1 × 10−3, 5 × 10−3, 4.1 × 10−2, and 3.4 × 10−2, respectively). Arrhythmia in one case (3.5%) and coronary artery abnormalities, including dilatation in two cases (7.1%) and small aneurysms in one case (3.5%) were identified. Regardless of ICU admission, no patients experienced systolic dysfunction or mortality following treatment.ConclusionMIS‐C cases in Taiwan have a favorable outcome. Although one‐third of the patients required PICU admission, none of the MIS‐C cases resulted in severe cardiovascular morbidity or mortality. This study provides valuable insights into the clinical manifestations and outcomes associated with PICU admission in children with MIS‐C in Taiwan.