Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
J Paediatr Child Health. 2022 Nov;58(11):1964-1971. doi: 10.1111/jpc.16129. Epub 2022 Jul 23.
To study the clinical profile and outcomes in children with multisystem inflammatory syndrome in children (MIS-C).
Children aged 1 month to 15 years presenting with MIS-C (May 2020 to November 2021) were enrolled. Clinical, laboratory, echocardiography parameters and outcomes were analysed.
Eighty-one children (median age 60 months (24-100)) were enrolled. Median duration of fever was 5 days (3-7). Twenty-nine (35.8%) had shock (severe MIS-C) including 23 (28.3%) requiring inotropes (median duration = 25 h (7.5-33)). Ten required mechanical ventilation, 12 had acute kidney injury and 1 child died. Left ventricular (LV) dysfunction was seen in 38 (46.9%), 16 (19.7%) had coronary artery abnormalities (CAA) and 13 (20%) had macrophage activation syndrome. Sixty-one (75.3%) were SARS CoV-2 positive (10 by RT-PCR and 51 by serology). Sixty-eight (83.9%) received immunomodulators. Younger age was significantly associated with CAA (P value = 0.05). Older age, LV dysfunction, SARS CoV-2 positivity, low platelet count and elevated serum ferritin were significantly associated with severe MIS-C (univariate analysis). Younger age was an independent predictor of CAA (P = 0.05); older age (P = 0.043) and low platelet count (P = 0.032) were independent predictors of severe MIS-C (multivariate logistic regression analysis).
Our patients had diverse clinical manifestations with a good outcome. Younger age was significantly associated with CAA. Older age, LV dysfunction, low platelet count and elevated serum ferritin were significantly associated with severe MIS-C. Younger age is an independent predictor of CAA. Older age and low platelet count are independent predictors of severe MIS-C.
研究儿童多系统炎症综合征（MIS-C）患儿的临床特征和结局。
纳入 2020 年 5 月至 2021 年 11 月期间出现 MIS-C 的 1 个月至 15 岁儿童。分析其临床、实验室、超声心动图参数和结局。
共纳入 81 例儿童（中位年龄 60 个月（24-100））。中位发热持续时间为 5 天（3-7）。29 例（35.8%）发生休克（严重 MIS-C），其中 23 例（28.3%）需要使用正性肌力药（中位持续时间为 25 小时（7.5-33））。10 例需要机械通气，12 例发生急性肾损伤，1 例死亡。38 例（46.9%）存在左心室功能障碍，16 例（19.7%）存在冠状动脉异常（CAA），13 例（20%）存在巨噬细胞活化综合征。61 例（75.3%）SARS CoV-2 阳性（10 例通过 RT-PCR，51 例通过血清学）。68 例（83.9%）接受免疫调节剂治疗。年龄较小与 CAA 显著相关（P 值=0.05）。年龄较大、左心室功能障碍、SARS CoV-2 阳性、血小板计数低和血清铁蛋白升高与严重 MIS-C 显著相关（单因素分析）。年龄较小是 CAA 的独立预测因素（P=0.05）；年龄较大（P=0.043）和血小板计数低（P=0.032）是严重 MIS-C 的独立预测因素（多因素逻辑回归分析）。
我们的患者临床表现多样，结局良好。年龄较小与 CAA 显著相关。年龄较大、左心室功能障碍、血小板计数低和血清铁蛋白升高与严重 MIS-C 显著相关。年龄较小是 CAA 的独立预测因素。年龄较大和血小板计数低是严重 MIS-C 的独立预测因素。
