Differentiation of COVID-19–Associated Multisystem Inflammatory Syndrome From Kawasaki Disease With the Use of Cardiac Biomarkers

Fridman, Michael D.; Tsoukas, Paul; Jeewa, Aamir; Yeung, Rae S. M.; Gamulka, Beth; McCrindle, Brian W.

doi:10.1016/j.cjca.2022.11.012

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…Raynor's study showed that increased NT-proBNP correlated with the severity of left ventricular dysfunction and was a better marker than BNP [58]. On the other hand, Fridman found that higher troponin I, not NT-proBNP, was associated with decreased LVEF [59]. Campanello reported that fibrinogen concentration was increased in children with reduced LVEF [55].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

et al. 2023

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Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cardiovascular system is commonly involved. Acute heart failure (AHF) is the most severe complication of MIS-C, leading to cardiogenic shock. The aim of the study was to characterise the course of MIS-C with a focus on cardiovascular involvement, based on echocardiographic (echo) evaluation, in 498 children (median age 8.3 years, 63% boys) hospitalised in 50 cities in Poland. Among them, 456 (91.5%) had cardiovascular system involvement: 190 (48.2%) of patients had (most commonly atrioventricular) valvular insufficiency, 155 (41.0%) had contractility abnormalities and 132 (35.6%) had decreased left ventricular ejection fraction (LVEF < 55%). Most of these abnormalities improved within a few days. Analysis of the results obtained from two echo descriptions (a median of 5 days apart) revealed a >10% increase in LVEF even in children with primarily normal LVEF. Lower levels of lymphocytes, platelets and sodium and higher levels of inflammatory markers on admission were significantly more common among older children with contractility dysfunction, while younger children developed coronary artery abnormality (CAA) more often. The incidence of ventricular dysfunction might be underestimated. The majority of children with AHF improved significantly within a few days. CAAs were relatively rare. Children with impaired contractility as well as other cardiac abnormalities differed significantly from children without such conditions. Due to the exploratory nature of this study, these findings should be confirmed in further studies.

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Section: Discussionmentioning

confidence: 99%

Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

et al. 2023

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“… 29 , 36 , 37 In their study comparing KD and MIS-C patients, Matsubara et al 38 also reported that patients with MIS-C exhibited poorer left ventricular systolic and diastolic functions in comparison to those with KD. Fridman et al 32 also showed more frequent ventricular dysfunction in MIS-C patients than in KD patients. Another study showed that cardiac involvement of MIS-C, although more severe and widespread compared to KD, has a relatively favorable prognosis, potentially leading to a decreased necessity for long-term follow-up after recovery.…”

Section: Discussionmentioning

confidence: 89%

“…Two previous studies focused on the differentiating features of MIS-C and contemporaneous KD. 31 , 32 Fernández-Cooke et al 31 compared the KD cases diagnosed during the COVID-19 period (from March 1 to May 30, 2020) that were either SARS-CoV-2 positive (n = 26) or negative (n = 20) to those from the same period during 2018 and 2019 (PreCoV) and with each other. Twenty-three (88.5%) of the SARS-CoV-2-positive patients fulfilled the MIS-C criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Severe acute respiratory syndrome coronavirus 2-positive patients were significantly older and mainly non-Caucasian and had lower leukocyte and platelet counts, higher inflammatory markers and BNP, less aneurysm development, and more myocardial dysfunction than others. Fridman et al 32 compared 38 MIS-C patients with 70 KD patients, 38 of whom were diagnosed during the pandemic. They showed that KD clinical features were less prevalent, while ventricular dysfunction, shock, inotrope requirement, and ICU admission were more common in MIS-C patients than in KD patients.…”

Section: Discussionmentioning

confidence: 99%

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Differentiating Multisystem Inflammatory Syndrome in Children from Kawasaki Disease During the Pandemic

Şener,

Batu,

Akca

et al. 2024

Turkish Archives of Pediatrics

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Objective: We aimed to delineate the distinctive characteristics that aid in distinguishing between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) with KD-like manifestations during the pandemic. Materials and Methods: We evaluated KD patients and MIS-C patients with KD-like symptoms admitted during the pandemic (between January 2021 and December 2022). Results: Thirty-three MIS-C patients and 15 KD patients were included. Kawasaki disease patients were younger than MIS-C patients (3.4 vs. 7.6 years). Rash ( P = .044, 100% vs. 75.7%), oral mucosal changes ( P = .044, 100% vs. 75.7%), and cervical lymphadenopathy ( P = .001, 93.3% vs. 42.4%) were more common in KD. Multisystem inflammatory syndrome in children: patients had more hypotension ( P = .002, 45.4% vs. 0), gastrointestinal ( P < .001, 72.7% vs. 13.3%), and respiratory symptoms ( P = .044, 24.2% vs. 0). Multisystem inflammatory syndrome in children patients also had low lymphocyte and thrombocyte counts and elevated levels of d -dimer, ferritin, and cardiac parameters, unlike KD patients. Multisystem inflammatory syndrome in children patients exhibited a notable reduction in left ventricular systolic function in echocardiography. Another significant difference with regard to management was the anakinra treatment, which was prescribed for MIS-C patients. Conclusion: Although MIS-C patients might display a clinical resemblance to KD, several features could help differentiate between MIS-C and classical KD. Specific clinical (hypotension, gastrointestinal, and respiratory symptoms) and laboratory (low lymphocyte and thrombocyte counts with higher C-reactive protein, ferritin, d -dimer, and cardiac parameters) features are characteristic of MIS-C. In addition, divergence in management strategies is evident between the 2 diseases, as biologic drugs were more prevalently employed in MIS-C patients than in classical KD patients.

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“…A similar importance of pro-BNP was reported in the study performed by Kaidar et al, where an increasing amount of pro-BNP could increase the risk of severe MIS-C by 8.4 times upon reaching levels above 8,000 ng/L ( 26 ). The significance of cardiac biomarkers in the early prediction of MIS-C in pediatric patients with COVID-19 has been determined in several studies ( 44 , 45 ). Gullu et al identified that a pro-BNP value of 282 ng/L or more alone had a striking sensitivity of 100% and a specificity of 93% with an AUC of 0.985, while an increase in troponin I was less sensitive (60%) but more specific (99.2%, AUC of 0.794) ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

Platelet role in the prediction of MIS-C severity

et al. 2023

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IntroductionMultisystem inflammatory syndrome in children (MIS-C) has been reported as one of the cytokine storm syndromes associated with COVID-19. Despite the several proposed diagnostic criteria, MIS-C remains a diagnostic and clinical challenge. Recent studies have demonstrated that platelets (PLTs) play a crucial role in COVID-19 infection and its prognosis. This study aimed to investigate the clinical importance of PLT count and PLT indices in predicting MIS-C severity in children.Patients and methodsWe conducted a retrospective single-center study at our university hospital. A total of 43 patients diagnosed with MIS-C during a 2-year period (from October 2020 to October 2022) were included in the study. MIS-C severity was evaluated according to the composite severity score.ResultsHalf of the patients were treated in the pediatric intensive care unit. No single clinical sign was associated with a severe condition, except for shock (p = 0.041). All the routine biomarkers, such as complete blood count (CBC) and C-reactive protein (CRP), used for MIS-C diagnosis were significant in predicting MIS-C severity. Single PLT parameters, such as mean PLT volume, plateletcrit, or PLT distribution width, did not differ between the severity groups. However, we found that a combination of PLT count and the previously mentioned PLT indices had the potential to predict MIS-C severity.ConclusionsOur study emphasizes the importance of PLT in MIS-C pathogenesis and severity. It revealed that together with routine biomarkers (e.g., CBC and CRP), it could highly improve the prediction of MIS-C severity.

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Differentiation of COVID-19–Associated Multisystem Inflammatory Syndrome From Kawasaki Disease With the Use of Cardiac Biomarkers

Cited by 8 publications

References 24 publications

Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

Differentiating Multisystem Inflammatory Syndrome in Children from Kawasaki Disease During the Pandemic

Platelet role in the prediction of MIS-C severity

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