The predictors of severe course of multisystem inflammatory syndrome associated with the new coronavirus infection COVID-19 in children: results of a retrospective-prospective multicenter study

• Published in: Pediatrician (St. Petersburg) Vol. 14; no. 1; pp. 45 - 59
• Main Authors: Avrusin, Ilia S., Abramova, Natalia N., Belozerov, Konstantin E., Efremova, Olesya S., Bregel, Lyudmila V., Kondratiev, Gleb V., Dondurey, Elena A., Vilnitz, Alla A., Konstantinova, Yulia E., Burtseva, Tatiana E., Vinnikova, Ekaterina I., Isupova, Evgeniya A., Kornishina, Tatiana L., Masalova, Vera V., Redkina, Maria V., Solodkova, Irina V., Kalashnikova, Olga V., Chasnyk, Vyacheslav G., Alexandrovich, Yuri S., Kostik, Mikhail M.
• Format: Journal Article
• Language: English
• Published: 18.04.2023
• ISSN: 2079-7850; 2587-6252
• DOI: 10.17816/PED14145-59

BACKGROUND:Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a rare but severe disease in which various organs and systems are affected, including heart, lungs, kidneys, brain, skin, eyes and organs of the gastrointestinal tract. MIS-C is rather difficult to diagnose, since it has much in common with the infectious process, and Kawasaki disease. However, MIS-C course is more severe and therefore patients need hospitalization in the intensive care unit in half of the cases. AIM:To determine the factors associated with severe course of MIS-C, requiring hospitalization of patients in the intensive care unit. MATERIALS AND METHODS:The retrospective study included 166 patients (99 boys, 67 girls), aged 4 months to 17 years (median 8.2 years), with a diagnosis of multisystem inflammatory syndrome associated with COVID-19 in children. To conduct a comparative analysis, patients with MIS-C were divided into two groups: group 1 patients hospitalized in the intensive care unit (n= 84, 50.6%), and group 2 patients who did not need hospitalization in the intensive care unit (n= 82, 49.4%). RESULTS:Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin and D-dimer levels. Also, in patients hospitalized in the intensive care unit, signs of hemophagocytic syndrome were more often observed. CONCLUSIONS:The main factors determining the severity of MIS-C are damage to the cardiovascular system, the central nervous system, the presence of respiratory and hemodynamic disorders, especially hemophagocytosis.