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

Abstract

BackgroundFew single center studies from resource-poor settings have reported about the epidemiology, clinical feature and outcome of multisystem inflammatory syndrome in children (MIS-C). However, larger data from multi-center studies on the same is lacking including from Indian setting.MethodsThis retrospective collaborative study constituted of data collected on MIS-C from five tertiary care teaching hospitals from Eastern India. Children ≤ 15 years of age with MIS-C as per the WHO criteria were included. Primary outcome was mortality.ResultsA total of 134 MIS-C cases were included (median age, 84 months; males constituted 66.7%). Fever was a universal finding. Rash was present in 40%, and conjunctivitis in 71% cases. Gastro-intestinal and respiratory symptoms were observed in 50.7% and 39.6% cases, respectively. Co-morbidity was present in 23.9% cases. Shock at admission was noted in 35%, and 27.38% required mechanical ventilation. Fifteen (11.2%) children died. The coronary abnormalities got normalized during follow-up in all except in one child. Initial choice of immunomodulation had no effect on the outcomes. Presence of underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were the factors significantly associated an increased mortality.ConclusionsMIS-C has myriad of manifestations. Underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were associated with an increased mortality. No difference in outcome was noted with either steroid or IVIg or both. Coronary artery abnormalities resolved in nearly all cases.

Multisystem Inflammatory Syndrome in Children Associated with COVID-19 Infection: Clinical Presentation and Outcome

“…In different studies, the median age ranges of MIS-C cases were between the age of 6 and 10 years which is comparable to our study with a median age of 8 years. [14][15][16][22][23][24][25][26] Some studies reported that there is a slight male predominance in MIS-C cases, 14,15,22,26 while others found slightly more female predisposition of MIS-C. 16,24,25 Our study did not find any gender predisposition which was similar to the other studies by Belhadjer et al, 27 Tiwari et al, 28 and Baradaran et al 29 Therefore, considering the data currently available, it cannot be opined that the probability of developing MIS-C is directly related with the sex of the patients. In our study, patients most frequently presented with persistent fever (100%), which is similar to findings in other studies about MIS-C. 15,23,[30][31][32] We observed that all the patients were positive for SARS-CoV-2 antibodies, while in other studies positive serology for was reported in 86 to 100% of cases.…”

“…In various studies, the use of systemic corticosteroids ranged from 65 to 95.65%. [14][15][16][22][23][24][25][26][27][28][29]36 Immunomodulator in the form of IVIG was used in 38.8% (n ¼ 7) of the patients. A systematic review by Ahmed et al 37 showed the use of corticosteroids and IVIG in 52.3 and 76.2% of cases, respectively.…”

“…In different studies, the median age ranges of MIS-C cases were between the age of 6 and 10 years which is comparable to our study with a median age of 8 years. 14 15 16 22 23 24 25 26…”

The Role of Mean Platelet Volume in Multisystem Inflammatory Syndrome in Children With Cardiac Manifestations

“…11,13,[28][29][30] Meanwhile, India, Pakistan and Colombia have reported MIS-C in younger children (median age, 2-7 years). [31][32][33][34] Routine blood testing is initially performed in children with fever. Leukocyte, neutrophil, lymphocyte and PLT counts may easily be obtained using an automatic hematology analyzer.…”

“…11,13,28–30 Meanwhile, India, Pakistan and Colombia have reported MIS-C in younger children (median age, 2–7 years). 31–34…”