COVID-19 associated multisystemic inflammatory syndrome in 614 children with and without overlap with Kawasaki disease-Turk MIS-C study group

Abstract

Multisystemic inflammatory syndrome (MIS-C) diagnosis remains difficult because the clinical features overlap with Kawasaki disease (KD). The study aims to highlight the clinical and laboratory features and outcomes of patients with MISC whose clinical manifestations overlap with or without KD. This study is a retrospective analysis of a case series designed for patients aged 1 month to 18 years in 28 hospitals between November 1, 2020, and June 9, 2021. Patient demographics, complaints, laboratory results, echocardiographic results, system involvement, and outcomes were recorded. A total of 614 patients were enrolled; the median age was 7.4 years (interquartile range (IQR) 3.9–12 years). A total of 277 (45.1%) patients with MIS-C had manifestations that overlapped with KD, including 92 (33.3%) patients with complete KD and 185 (66.7%) with incomplete KD. Lymphocyte and platelet counts were significantly lower in patients with MISC, overlapped with KD (lymphocyte count 1080 vs. 1280 cells × μL, p = 0.028; platelet count 166 vs. 216 cells × 10 3 /μL, p < 0.001). The median serum procalcitonin levels were statistically higher in patients overlapped with KD (3.18 vs. 1.68 µg/L, p = 0.001). Coronary artery dilatation was statistically significant in patients with overlap with KD (13.4% vs. 6.8%, p = 0.007), while myocarditis was significantly more common in patients without overlap with KD features (2.6% vs 7.4%, p = 0.009). The association between clinical and laboratory findings and overlap with KD was investigated. Age > 12 years reduced the risk of overlap with KD by 66% ( p < 0.001, 95% CI 0.217–0.550), lethargy increased the risk of overlap with KD by 2.6-fold ( p = 0.011, 95% CI 1.244–5.439), and each unit more albumin (g/dl) reduced the risk of overlap with KD by 60% ( p < 0.001, 95% CI 0.298–0.559). Conclusion : Almost half of the patients with MISC had clinical features that overlapped with KD; in particular, incomplete KD was present. The median age was lower in patients with KD-like features. Lymphocyte and platelet counts were lower, and ferritin and procalcitonin levels were significantly higher in patients with overlap with KD. What is Known: • In some cases of MIS-C, the clinical symptoms overlap with Kawasaki disease. • Compared to Kawasaki disease, lymphopenia was an independent predictor of MIS-C. What is New: • Half of the patients had clinical features that overlapped with Kawasaki disease. • In patients whose clinical features overlapped with KD, procalcitonin levels were almost 15 times higher than normal. • Lethargy increased the risk of overlap with KD by 2.6-fold in MIS-C pa...

Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID-19: A Single-Center Experience

“…In addition, they found that the need for intensive care and shock development were more common in patients who did not overlap with KD. 32 In our study, there was an increase in inflammatory indicators including CRP, procalcitonin, ESR, ferritin, IL-6, and fibrinogen consistent with larger sample size studies. 16,23 In addition, thrombocytopenia, hypoalbuminemia, and high D-dimer levels were detected in the studies.…”

“…Ciftdogan et al evaluated 614 patients with MIS-C. 32 The researchers classified patients according to whether or not they had clinical findings overlapping with KD, and compared laboratory findings in the two groups. In this study, 45.1% of patients with MIS-C had manifestations that overlapped with KD.…”

Free flap reconstruction of distal extremity necrosis after COVID‐19‐related multisystem inflammatory syndrome in a pediatric patient

“…(Bowles et al, 2020) Recent reports on MIS-C after SARS-CoV-2 infection have also shown a frequent overlap of its clinical features with Kawasaki disease and other viral-associated hyperinflammatory syndromes, making an accurate diagnosis challenging. (Yilmaz Ciftdogan et al, 2022) Pathogenesis of Kawasaki-like MIS-C is thought to be immune complex-mediated, which derives in activation of inflammatory cells (including monocytes and neutrophils) and recruitment of platelets, resulting in thrombocytosis (commonly seen in Kawasaki disease and presented in our patient). (Lo & Newburger, 2018) Although there are several studies aiming to describe the pathophysiology and clinical characteristics of this condition, reports including specific recommendations for patients with MIS-C who also have surgical indications are mainly null.…”

Heterogeneity in the evaluation of suspected MIS-C: a cross-sectional vignette-based survey

“…This lack of clarity is reflected in our study, where providers were divided when asked about the duration of fever that would prompt them to initiate workup. Additional thought also must be put into excluding other febrile illnesses, such as viral illnesses, bacterial infections, or Kawasaki disease, which can be particularly challenging given the overlapping clinical features [ 11 ].…”