Department of Rheumatology and Clinical Immunology, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
Department of Pediatrics, Baby Memorial Hospital, Calicut, Kerala, India.
BMJ Paediatr Open. 2021 Oct 18;5(1):e001195. doi: 10.1136/bmjpo-2021-001195. eCollection 2021.
To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity.
Hospital-based prospective cohort study.
Two tertiary care centres in Kerala, India.
Diagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention.
Pearson χ test or Fisher's exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni's correction was used for multiple comparisons.
We report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes.
Patients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation.
研究（1）与 COVID-19 相关儿童多系统炎症综合征（MIS-C）相关的流行病学因素、临床特征和结局，（2）不同年龄组的临床特征，（3）中期结局，以及（4）与疾病严重程度相关的参数。
医院为基础的前瞻性队列研究。
印度喀拉拉邦的两个三级保健中心。
根据疾病控制和预防中心的病例定义，确诊为 MIS-C 的患者。
采用 Pearson χ 检验或 Fisher's 确切检验比较分类变量，采用独立样本 t 检验或 Mann-Whitney 检验比较按机械通气要求分组的亚组间的连续变量。采用 Bonferroni 校正进行多重比较。
我们报告了 41 例 MIS-C 患者，平均年龄为 6.2（4.0）岁，33 例（80%）既往健康。23 例（56%）存在超声心动图异常，15 例（37%）患者存在冠状动脉异常。39 例（95%）接受免疫调节治疗，35 例（85%）使用类固醇和 IVIg，3 例（7%）仅使用类固醇。36 例（88%）需要重症监护，8 例（20%）需要机械通气，21 例（51%）需要正性肌力支持，2 例（5%）患者死亡。MIS-C 患者机械通气需求与高 ferritin 血症相关（p=0.001）。2021 年 4 月前，37 例患者完成 3 个月随访，其中 6 例（16%）患者存在一些残留的超声心动图改变。
我们队列中的 MIS-C 患者临床表现多样，从发热伴轻度胃肠道和黏膜皮肤受累到致命的多器官功能障碍不等。除少数患者存在超声心动图后遗症外，近期和中期结局仍基本良好，且这些后遗症也呈消退趋势。高 ferritin 血症与机械通气需求相关。
