Comparison of clinical and laboratory profile of survivors and non‐survivors of SARS‐CoV‐2‐related multisystem inflammatory syndrome of childhood in India: An observational study

Abstract

Aim The SARS‐CoV‐2 pandemic is characterised by multiple reports of paediatric multisystem inflammatory disease or multisystem inflammatory syndrome in children (MIS‐C) with Kawasaki disease‐like features often complicated by myocarditis, shock and macrophage activation syndrome. Certain clinical and laboratory markers may be used to identify high risk cases. Methods All sequentially admitted patients hospitalised between April 2020 and October 2020, who met the WHO case definition for MIS‐C were included. Data included patient demographic information, presenting symptoms, organ dysfunction and laboratory parameters. SARS‐CoV‐2 infection was diagnosed by nasopharyngeal swab real‐time reverse transcription‐polymerase chain reaction and/or rapid antibody test for SARS‐CoV‐2 as recommended. The clinical and laboratory criteria were compared in the survival and non‐survival groups. Results A total of 29 patients with MIS‐C were treated during the study period. There were 21 survivors and 8 non‐survivors. The non‐survivors had more neurocognitive and respiratory symptoms along with increased incidence of myocarditis compared with survivors. The serum levels of CPK‐MB, D‐dimer, ferritin and triglyceride were significantly raised in non‐survivors as compared to survivors. Conclusion The non‐survivor group had higher CPK and greater proportion of children with troponin‐T elevation indicating higher incidence of myocardial injury and necrosis. The D‐dimer, ferritin and triglyceride were also higher in the mortality group, indicating the greater extent of inflammatory damage in this group.

Initial Immunomodulation and Outcome of Children with Multisystem Inflammatory Syndrome Related to COVID-19: A Multisite Study from India

“…The mortality observed in the present study subjects is strikingly higher than other large series from developed nations (10.87% vs. 1%-2%). High mortality (27.5%) has also been reported from a single-center study from India, which has not participated in the present study [12].…”

“…Similarly, a retrospective study in a French cohort with 181 children also showed a favorable outcome in terms of early defervescence, the requirement of inotropic support, and duration of intensive care stay in the group receiving both IVIG and methylprednisolone as compared to IVIG alone [8]. However, there were differences in the predefined primary outcomes of these studies [10][11][12]; cardiac dysfunction or shock on or after day 2 in the study by Son et al [9]; the persistence of fever 2 d after the introduction of initial therapy or recrudescence of fever within 7 d in the French cohort [8], compared to the composite outcome (requirement of vasoactive/inotropic support for ≥ 2 d or need of mechanical ventilation ≥ 2 d after initiation of immunomodulatory treatment or death during hospitalization), in the Best Available Treatment Study (BATS) by McArdle et al [10]. In the present study, death was also included as a primary outcome.…”

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

“…The high mortality rate (12.9%) observed in the present series is in stark contrast to that reported from multi-hospital data from US [ 8 , 21 ]. The reported mortality in Indian series ranges from 0 to 27.5% [ 14 , 15 , 24 ]. All children who succumbed to illness in our series had underlying comorbidities, which might have contributed to poor outcomes.…”

“…The only series reporting higher mortality (27.5%) than ours, by Maheshwari et al didn’t mention about the underlying comorbidities. The other speculated factors contributing toincreased mortality in resource-poor settings include delayed referral to tertiary care centers and delay in instituting timely immunomodulation [ 24 ].…”

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

“…A higher rate of death (11.2%) noted in our study is similar to that reported in previous Indian study (12.9%) ( 13 ). Other Indian studies have reported mortality rate varying from 0 to 27.5% ( 17 , 18 , 31 ). However, these figures are much higher than those reported in the previous systematic review, and multi-center data from USA ( 12 , 15 ).…”