COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India

Abstract

ObjectivesTo study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity.DesignHospital-based prospective cohort study.SettingTwo tertiary care centres in Kerala, India.ParticipantsDiagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention.Statistical analysisPearson χ2 test or Fisher’s exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni’s correction was used for multiple comparisons.ResultsWe report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes.ConclusionsPatients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation.

Clinical profile and outcomes of multisystem inflammatory syndrome in children (MIS‐C): Hospital‐based prospective observational study from a tertiary care hospital in South India

“…We compared the baseline, clinical characteristics, cardiac and investigative parameters of our study with previously published studies from India (Table 4). [11][12][13][14][15][16][17][18] The mean age among these studies ranged from 60 to 90 months with GI symptoms as the predominant presenting manifestation. Details of these studies, including presence of shock, requirement of inotrope infusion, mechanical ventilation, ICU requirement, presence of CAA and LV systolic function and SARS CoV-2 positivity among the patients, have been summarised.…”

Evaluation of Baseline Characteristics and Prognostic Factors in Multisystemic Inflammatory Syndrome in Children: Is It Possible to Foresee the Prognosis in the First Step?

“…In this study, SVM and Naïve Bayes algorithms were the best in overall accuracy, while the logistic regression model resulted in the most sensitive results. In clinical studies and systemical reviews, the main biomarkers that are related to severe condition are elevated CRP [ 15 , 16 ], ferritin [ 11 , 15 , 16 , 21 , 25 , 29 , 30 ], BNP [ 15 , 21 ], D-dimer [ 15 , 16 , 31 ], troponin [ 15 , 16 , 21 ] levels, and reduced platelet [ 12 ] and lymphocyte counts [ 15 , 16 , 21 ]. Although it has been shown that various advanced markers such as IL-6, IL-10, IL-17A, and interferon-gamma (IFN-γ) have prognostic value, limited availability is the main obstacle to their widespread use [ 15 , 16 , 32 ].…”

Clinical profile of multisystem inflammatory syndrome in children associated with COVID-19 in a rural medical college

“…Only few studies found girls to be affected more. 2,3,8,[13][14][15][16][17] Most of the cases recovered. Only 4 (6%) patients died in this study.…”

“…2,3,11 However Indian studies have reported mortality rate ranging from 0 to 27.5%. [13][14][15][16][18][19][20] Mortality was higher in children with associated co-morbidities. Two out of four children (50%) died who had co-morbidities.…”