tetano
Editor, Senior Moderator
Rheumatol Int
. 2021 Oct 19.
doi: 10.1007/s00296-021-05030-y. Online ahead of print.
Outcomes of multisystem inflammatory syndrome in children temporally related to COVID-19: a longitudinal study
Narendra Kumar Bagri[SUP] 1 [/SUP], Rakesh Kumar Deepak[SUP] 2 [/SUP], Suneeta Meena[SUP] 3 [/SUP], Saurabh Kumar Gupta[SUP] 4 [/SUP], Satya Prakash[SUP] 5 [/SUP], Kritika Setlur[SUP] 5 [/SUP], Jagatshreya Satapathy[SUP] 5 [/SUP], Karan Chopra[SUP] 5 [/SUP], Ashish Datt Upadhyay[SUP] 6 [/SUP], Sivasubramanian Ramakrishnan[SUP] 4 [/SUP], Rakesh Lodha[SUP] 5 [/SUP], Lalit Dar[SUP] 7 [/SUP], Anjan Trikha[SUP] 8 [/SUP], Sushil Kumar Kabra[SUP] 5 [/SUP]
Affiliations
Abstract
To study the clinical, laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to coronavirus disease 2019 (COVID-19) in a resource-limited setting. All children meeting the World Health Organization case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4-6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the stata-12 software. Thirty-one children with MIS-C were enrolled in an 11-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding; gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight percent of children presented with shock, and 22.5% required mechanical ventilation. HSP like rash, gangrene and arthritis were uncommon clinical observations.The median duration of hospital stay was 9 (6.5-18.5) days: four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in non-survivors as compared to survivors [1061 (581, 2750) vs 309.5 (140, 720.08), p value = 0.045]. Six patients had coronary artery involvement; five recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome. Most children with MIS-C present with acute hemodynamic and respiratory symptoms.The outcome is favorable in children without preexisting comorbidities.Raised ferritin level may be a poor prognostic marker. The coronary outcomes at follow-up were reassuring.
Keywords: Coronary artery outcomes; MIS-C; MIS-C and Kawasaki disease; SARS-CoV-2.
. 2021 Oct 19.
doi: 10.1007/s00296-021-05030-y. Online ahead of print.
Outcomes of multisystem inflammatory syndrome in children temporally related to COVID-19: a longitudinal study
Narendra Kumar Bagri[SUP] 1 [/SUP], Rakesh Kumar Deepak[SUP] 2 [/SUP], Suneeta Meena[SUP] 3 [/SUP], Saurabh Kumar Gupta[SUP] 4 [/SUP], Satya Prakash[SUP] 5 [/SUP], Kritika Setlur[SUP] 5 [/SUP], Jagatshreya Satapathy[SUP] 5 [/SUP], Karan Chopra[SUP] 5 [/SUP], Ashish Datt Upadhyay[SUP] 6 [/SUP], Sivasubramanian Ramakrishnan[SUP] 4 [/SUP], Rakesh Lodha[SUP] 5 [/SUP], Lalit Dar[SUP] 7 [/SUP], Anjan Trikha[SUP] 8 [/SUP], Sushil Kumar Kabra[SUP] 5 [/SUP]
Affiliations
- PMID: 34665296
- DOI: 10.1007/s00296-021-05030-y
Abstract
To study the clinical, laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to coronavirus disease 2019 (COVID-19) in a resource-limited setting. All children meeting the World Health Organization case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4-6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the stata-12 software. Thirty-one children with MIS-C were enrolled in an 11-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding; gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight percent of children presented with shock, and 22.5% required mechanical ventilation. HSP like rash, gangrene and arthritis were uncommon clinical observations.The median duration of hospital stay was 9 (6.5-18.5) days: four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in non-survivors as compared to survivors [1061 (581, 2750) vs 309.5 (140, 720.08), p value = 0.045]. Six patients had coronary artery involvement; five recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome. Most children with MIS-C present with acute hemodynamic and respiratory symptoms.The outcome is favorable in children without preexisting comorbidities.Raised ferritin level may be a poor prognostic marker. The coronary outcomes at follow-up were reassuring.
Keywords: Coronary artery outcomes; MIS-C; MIS-C and Kawasaki disease; SARS-CoV-2.