Severity Predictors for Multisystemic Inflammatory in Children after SARS-CoV-2 Infection: A Prospective Observational Study from Vietnam

Abstract

Multisystemic inflammatory in children (MIS-C) might manifest in a broad spectrum of clinical scenarios, ranging from mild features to multi-organ dysfunction and mortality. However, this novel entity has a heterogenicity of data regarding prognostic factors associated with severe outcomes. The present study aimed to identify independent predictors for severity by using multivariate regression models. A total of 391 patients (255 boys and 136 girls) were admitted to Vietnam National Children’s Hospital from January 2022 to June 2023. The median age was 85 (range: 2–188) months, and only 12 (3.1%) patients had comorbidities. 161 (31.5%) patients required PICU admission, and the median PICU LOS was 4 (2–7) days. We observed independent factors related to PICU admission, including CRP \(\ge\)50 (mg/L) (OR = 2.52, 95%CI;1.39–4.56, p = 0.002), albumin \(\le\)30 (g/L) (OR = 3.18, 95%CI;1.63–6.02, p = 0.001), absolute lymphocyte count \(\le\)2 (×109/L) (OR = 2.18, 95%CI;1.29–3.71, p = 0.004), ferritin ≥300 (ng/mL) (OR = 2.35, 95%CI;1.38–4.01), p = 0.002), and LVEF < 60 (%) (OR = 2.48, 95%CI;1.28–4.78, p = 0.007). Shock developed in 140 (35.8%) patients, especially for those decreased absolute lymphocyte \(\le\)2 (×109/L) (OR = 2.48, 95%CI;1.10–5.61, p = 0.029), albumin \(\le\)30 (g/L) (OR = 2.53, 95%CI;1.22–5.24, p = 0.013), or LVEF <60 (%) (OR = 2.24, 95%CI;1.12–4.51, p = 0.022). In conclusion, our study emphasized that absolute lymphocyte count, serum albumin, CRP, and LVEF were independent predictors for MIS-C severity, which required further well-designed investigations on validation. As MIS-C is a new entity and severe courses may progress aggressively, the identification of high-risk patients optimizes clinicians' follow-up and management to improve disease outcomes.