Clinical spectrum and prognostic markers of multi-system inflammatory syndrome in children hospitalised in Northern India

• Main Authors: Areesha Alam (Author), Nishant Verma (Author), Shally Awasthi (Author), Dipti Agarwal (Author), Krishna Kumar Yadav (Author), Pradeep Kumar Gupta (Author), Ranjeeta Dadoria (Author), Anita Mehta (Author), Kuldeep Singh (Author), Moinak Sen Sarma (Author), Amita Aggarwal (Author), Banani Poddar (Author), Vijay jaiswal (Author), Anupama Verma (Author), Sangita Singhal (Author), Bipin Puri (Author)
• Format: Book
• Published: Elsevier, 2023-09-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Background: Multi-system inflammatory syndrome in children (MIS-C) is characterized by hyper-inflammation and multi-organ dysfunction with antecedent SARS-CoV-2 infection. To describe clinical, laboratory characteristics and outcome of children with MIS-C in a low-middle-income-country and to evaluate factors associated with mortality. Methods: Cases (<18 years) fulfilling WHO case-definition of MIS-C from 7 hospitals in Northern-India were included. Clinical, laboratory and treatment variables were compared between survivors and non-survivors using univariate analysis. Logistic regression analysis was performed to identify their independent association with mortality using Model 1: clinical and laboratory parameters and Model 2: clinical, laboratory and treatment parameters. Results: From May to October 2021, 98 children were enrolled with mean age (SD) of 79 months (54.2) and male preponderance (68.4%). Median (IQR) duration to diagnosis was 6 (4-9) days. Clinical features included fever (100%), gastrointestinal manifestations (70.4%), rash (62.2%), non-purulent conjunctivitis (40.8%) and inflammation of oral-mucosa (32.7%) and extremities (31.6%). Shock was noted in 40%, myocardial dysfunction in 39% and coagulopathy in 98.9% of cases. Seventy-five (76.5%) children required ICU admission and 16.3% required Mechanical ventilation (MV). Mortality rate was 18.4%. Logistic regression model 1 identified C - reactive protein (CRP) > 50 mg/L [aOR 9.6 (95% CI 1.8-50.9)] and Prothrombin Time (PT) > 17 seconds at presentation [aOR 13.6 (95% CI 1.6-118.9)] to be independently associated with mortality. Need of MV emerged as independent predictor of mortality on Model 2. Conclusions: Children with MIS-C having high CRP and PT at presentation are at increased odds of dying and require intensive monitoring.

Item Description

2213-3984
10.1016/j.cegh.2023.101357