Paediatrics Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain.
Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain.
Eur J Pediatr. 2023 Nov;182(11):5109-5118. doi: 10.1007/s00431-023-05168-w. Epub 2023 Sep 7.
Differential diagnosis between Multisystem Inflammatory Syndrome in Children (MIS-C) and other causes of systemic inflammatory response such as sepsis is complex. The aims were to evaluate the differences between pediatric patients with MIS-C and sepsis and to develop a score to distinguish both entities. This was a retrospective study that compared demographic, clinical, diagnostic, and therapeutic data of pediatric patients with MIS-C (cohort 2020-2022) and sepsis (cohorts 2010-2014 and 2017-2018) admitted to a Pediatric Intensive Care Unit (PICU) of a tertiary care hospital. A diagnostic score was developed with variables that differentiated the two conditions. Twenty-nine patients with MIS-C were identified, who were matched 1:3 with patients with sepsis (n = 87). Patients with MIS-C were older (10 vs. 4 years old), and the majority were male (69%). Clinical characteristics that demonstrated differences were prolonged fever and signs and symptoms affecting skin-mucosa and gastrointestinal system. Leukocytes, PCT, and ferritin were higher in sepsis, while thrombocytopenia, lymphopenia, and elevated fibrinogen and adrenomedullin (biomarker with a role for the detection of invasive infections) were more frequent in MIS-C. MIS-C patients presented greater myocardial dysfunction (p < 0.001). Five criteria were selected and included in the MISSEP score after fitting them into a multivariate logistic regression model: fever > 48 hours (20 points), thrombocytopenia < 150 × 10/µL (6 points), abdominal pain (15 points), conjunctival erythema (11 points), and Vasoactive Inotropic Score (VIS) > 10 (7 points). The cutoff > 25 points allowed to discriminate MIS-C from sepsis with a sensitivity of 0.89 and specificity of 0.95. Conclusion: MIS-C phenotype overlaps with sepsis. MISSEP score could be useful to distinguish between both entities and direct specific treatment. What is Known: • Differential diagnosis between Multisystem Inflammatory Syndrome in Children (MIS-C) and other causes of systemic inflammatory response such as sepsis is complex. • It is essential to establish an accurate initial diagnosis and early specific treatment in both cases of MIS-C and sepsis to improve the prognosis of these patients. What is New: • Patients with MIS-C are older and have characteristic symptoms of prolonged fever, gastrointestinal symptoms, skin-mucosal involvement, and greater myocardial dysfunction, compared to patients with sepsis. • The use of diagnostic scores, such as the MISSEP score, can be very useful to distinguish between the two entities and help direct specific treatment.
儿童多系统炎症综合征（MIS-C）与其他全身炎症反应病因（如脓毒症）的鉴别诊断较为复杂。本研究旨在评估儿科 MIS-C 患者与脓毒症患者之间的差异，并建立一种评分系统来区分这两种疾病。这是一项回顾性研究，比较了 2020-2022 年入住一家三级医院儿科重症监护病房（PICU）的 MIS-C（2020-2022 年队列）和脓毒症（2010-2014 年和 2017-2018 年队列）患儿的人口统计学、临床、诊断和治疗数据。使用能够区分两种疾病的变量建立了一种诊断评分。共确定了 29 例 MIS-C 患儿，并与脓毒症患儿（n=87）按 1:3 比例进行匹配。MIS-C 患儿年龄较大（10 岁 vs. 4 岁），且大多数为男性（69%）。临床表现方面，MIS-C 患儿发热时间较长，且皮肤黏膜和胃肠道系统受累症状更为常见。白细胞、降钙素原和铁蛋白在脓毒症中较高，而血小板减少、淋巴细胞减少、纤维蛋白原和肾上腺髓质素（一种对侵袭性感染有检测作用的生物标志物）升高在 MIS-C 中更为常见。MIS-C 患儿心肌功能障碍更为严重（p<0.001）。通过多元逻辑回归模型拟合后，选择了 5 个标准并将其纳入 MISSEP 评分：发热>48 小时（20 分）、血小板计数<150×10/µL（6 分）、腹痛（15 分）、结膜红斑（11 分）和血管活性正性肌力药评分（VIS）>10（7 分）。截断值>25 分可将 MIS-C 与脓毒症区分开，其灵敏度为 0.89，特异性为 0.95。结论：MIS-C 表型与脓毒症重叠。MISSEP 评分可用于区分这两种疾病并指导特定治疗。已知内容：• MIS-C 与其他全身炎症反应病因（如脓毒症）的鉴别诊断较为复杂。• 对于 MIS-C 和脓毒症患者，早期建立准确的初始诊断和进行特异性治疗至关重要，这有助于改善患者的预后。新内容：• 与脓毒症患者相比，MIS-C 患儿年龄更大，具有特征性的发热时间较长、胃肠道症状、皮肤黏膜受累和心肌功能障碍更为严重等症状。• 使用诊断评分（如 MISSEP 评分）有助于区分这两种疾病并指导特定治疗。
