Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)

Abstract

Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.

Multisystemic Inflammatory Syndrome in Children From the South of Colombia: One Year of Experience

“…These findings are similar to those reported for Latin America ( 9 , 14 ) but differ from those reported in the United States where about 99% of the patients had positive IgG-type serology for SARS-CoV-2 ( 19 ). This latter is in contrast to what was reported in another Colombian study where 67% of the patients had positive RT-PCR and only 13% had positive serology for SARS-CoV-2 ( 18 ).…”

“…The most frequent treatment was intravenous human immunoglobulin used in 85% of the cases, followed by the use of ASA (73%). Glucocorticoids were used in 10 patients and always in combination with immunoglobulin; this is similar to what has been reported in different studies worldwide ( 9 , 14 , 18 ). Nowadays, there are no prospective studies evaluating the best therapy, but most of them have shown the effectiveness of the use of immunoglobulin, steroid, or a combination of these in the management of patients with MIS-C ( 12 , 20 ).…”

“…It was found that the male gender was the most affected in 52.9% of the cases, as well as children older than 5 years, with a 68-month median age of presentation, similar to that described in Europe, America, and Latin America ( 9 , 14 , 19 , 21 ). In relation to the patients' nutritional status, Colombia being a middle-high-income country, according to the World Bank classification ( 24 ), it was documented that 20% of the cases had some malnutrition, much higher than that reported in Brazil, where this comorbidity is reported in 9.1% of the cases ( 14 ) in contrast to that reported by Acevedo et al ( 18 ), in which the patients were obese and overweight by 30% and malnourished by 5.1%.…”

“…Currently in Colombia, the behavior of the infection by SARS-CoV-2( 15 ) and some cases of the behavior of the MIS-C have been reported, focused on patients who require care in the pediatric intensive care unit (PICU) ( 16 – 18 ).…”

The Multifaceted Presentation of the Multisystem Inflammatory Syndrome in Children: Data from a Cluster Analysis

“…Furthermore, Verdoni et al [ 11 ] reported a 30-fold increased risk for that Kawasaki-like disease in patients infected with SARS-CoV-2, and in the same line, they declared an increased risk of MAS and shock in patients with MIS-C. MIS-C is a rare and serious inflammatory condition associated with COVID-19. The mortality rate varies from 1% to 9% according to multicenter studies [ 12 , 13 , 14 ]. Although initial reports announced this new condition as a Kawasaki-like disease, it is well known now that patients with MIS-C may present with different system involvements.…”