The clinical course and short-term health outcomes of multisystem inflammatory syndrome in children in the single pediatric rheumatology center

Sözeri, Betül; Çağlayan, Şengül; Atasayan, Vildan; Ulu, Kadir; Coşkuner, Taner; Akbay, Özge Pelin; Akkuş, Canan Hasbal; Atay, Gürkan; Salı, Enes; Karacan, Mehmet; Öner, Taliha; Erdoğan, Seher; Demir, Ferhat

doi:10.1080/00325481.2021.1987732

Cited by 19 publications

(29 citation statements)

References 47 publications

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“…In our study, gastro-intestinal symptoms were observed in 50.37% cases, which was lower than that reported in other studies ( 13 , 25 , 26 ) but more than the Latin American study ( 24 ). The figure is still much lesser than that reported in the systematic review (85.6%) ( 12 ), which may be because of a larger sample size in the later.…”

Section: Discussioncontrasting

confidence: 85%

“…This is in agreement with the epidemiology of MIS-C, which indicates that majority of the cases develop 4–6 weeks after exposure to the virus ( 27 ). In our study, 23.9% had underlying co-morbidities, whereas it was 38.7% in the previous Indian study ( 13 ), 28.35% in Turkish study ( 26 ), and 15.8% in the Latin American study ( 24 ).…”

Section: Discussioncontrasting

confidence: 71%

“…In our study, rash was reported in 40% cases compared to 57.14% in the previous Indian study ( 12 ), 68% in the Brazilian study ( 25 ), and 54.9% in a systemic review ( 12 ). Our study reported a higher rate of non-purulent conjunctivitis (71%) compared to 25.8% in the Indian study ( 13 ), 31.3% in the Turkish study ( 26 ), and 49.8% reported in the systematic review ( 12 ).…”

Section: Discussioncontrasting

confidence: 53%

“…Second most common were the respiratory symptoms (39.26%), which is similar to that reported in the Latin American study ( 24 ), but lower than that reported in the systematic review ( 12 ), the Brazilian study ( 25 ) and the previous Indian study (67.74%) ( 13 ). For unknown reason, the Turkish study reported a much lesser frequency of respiratory symptoms (7.4%) compared to all the studies ( 26 ).…”

Section: Discussionmentioning

confidence: 67%

“…CAAs were seen in 10.45% of our cases, which was similar to that reported in the systematic review ( 12 ). Lowest incidence of CAAs was reported in the Turkish study (6.45%) ( 26 ), and highest in the Brazilian study (27%) ( 25 ). The later figures may correspond to the incidence of Kawasaki disease (KD) in these countries, as KD and MIS-C probably share similar patho-physiologic mechanisms ( 29 ).…”

Section: Discussionmentioning

confidence: 73%

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

et al. 2022

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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.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussioncontrasting

confidence: 71%

Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 73%

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

et al. 2022

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Cardiac manifestations in children with the multisystem inflammatory syndrome (MIS‐C) associated with SARS‐CoV‐2 infection: Systematic review and meta‐analysis

Arantes

Conegundes

Miranda

et al. 2023

Reviews in Medical Virology

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According to the World Health Organisation, as of October 2022, there have been 55,560,329 reported cases of SARS‐COV‐2 in patients under 19 years old. It is estimated that about 0.06% of these patients may develop MIS‐C, representing more than 2 million children worldwide. This systematic review and meta‐analysis examined the pooled prevalence of cardiovascular manifestation and cardiac complications in children hospitalised with MIS‐C. The PROSPERO register number is CRD42022327212. We included case‐report studies, case‐control studies, cohort studies, and cross‐sectional studies, as well as clinical trials or studies describing cardiac manifestations of MIS‐C and its sequelae in a paediatric population. Initially, 285 studies were selected, but there were 154 duplicates, and 81 were excluded because they did not fit the eligibility criteria. Thus, 50 studies were selected for review, and 30 were included in the meta‐analysis. A total sample size of 1445 children was included. The combined prevalence of myocarditis or pericarditis was 34.3% (95% CI: 25.0%–44.2%). The combined prevalence for echocardiogram anomalies was 40.8% (95% CI: 30.5%–51.5%), that of Kawasaki disease presentation was 14.8% (95% CI: 7.5%–23.7%), and that of coronary dilation was 15.2% (95% CI: 11.0%–19.8%). The rate of electrocardiogram anomalies was 5.3% (95% CI: 0.8%–12.3%), and the mortality rate was 0.5% (CI 95%: 0%–1.2%). Furthermore, 186 children still had complications at discharge, with a combined prevalence of such long‐lasting manifestations of 9.3% (95% CI: 5.6%–13.7%). Studies that assess whether these children will have an increased cardiovascular risk with a greater chance of acute myocardial infarction, arrhythmias, or thrombosis will be essential for healthcare planning.

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Multisystem inflammatory syndrome in children: clinical presentation, management, and short- and long-term outcomes

et al. 2022

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Objective In this study, it was aimed to evaluate the demographic, clinical and laboratory characteristics of MIS-C patients in our hospital, to share our treatment approach, and to assess the outcomes of short-and long-term follow-up. Methods MIS-C patients who were admitted and treated in our hospital between July 2020 and July 2021 were evaluated. Demographic, clinical, laboratory, and follow-up data were collected from patient records retrospectively. Results A total of 123 patients with MIS-C (median age, 9.6 years) were included the study. Nineteen (15.4%) were mild, 56 (45.6%) were moderate, and 48 (39%) were severe MIS-C. High CRP, ferritin, pro-BNP, troponin, IL-6, and D-dimer values were found in proportion to the severity of the disease (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.005, p < 0.001), respectively. Two (1.6%) patients died. The mean follow-up period was 7.8 months. Valve failure, left ventricular dysfunction/ hypertrophy, coronary involvement, and pericardial effusion were the most common cardiac pathologies in the short-and long-term follow-up of the patients. In the long-term follow-up, the most common reasons for admission to the hospital were recurrent abdominal pain (14.2%), cardiac findings (14.2%), pulmonary symptoms (8%), fever (7.1%), neuropsychiatric findings (6.2%) and hypertension (3.5%). Neuropsychiatric abnormalities were observed significantly more common in severe MIS-C patients at follow-up (p = 0.016). In the follow-up, 6.2% of the patients required recurrent hospitalization. Conclusion MIS-C is a serious and life-threatening disease, according to short-term outcomes. In addition to the cardiac findings of patients with MIS-C, long-term outcomes such as neuropsychiatric findings, persistent gastrointestinal symptoms, fever and pulmonary symptoms should be monitored. Key Points• In MIS-C patients, attention should be paid not only to cardiac findings, but also to symptoms related to other systems. • Patients should be followed up in terms of neuropsychiatric findings, persistent gastrointestinal symptoms, fever and pulmonary symptoms that may occur during follow-up.

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The clinical course and short-term health outcomes of multisystem inflammatory syndrome in children in the single pediatric rheumatology center

Cited by 19 publications

References 47 publications

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

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

Cardiac manifestations in children with the multisystem inflammatory syndrome (MIS‐C) associated with SARS‐CoV‐2 infection: Systematic review and meta‐analysis

Multisystem inflammatory syndrome in children: clinical presentation, management, and short- and long-term outcomes

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