Fan Lucie K, Bai Shasha, Du Chenxi, Bass Marissa, Jones Kaitlin, Sherry Whitney, Morris Claudia R, Oster Matthew E, Shane Andi L, Jaggi Preeti
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia.
Hosp Pediatr. 2023 Oct 1;13(10):e280-e284. doi: 10.1542/hpeds.2022-007107.
Characterizing inflammatory syndromes during the coronavirus disease 2019 pandemic was complicated by recognition of multisystem inflammatory syndrome in children (MIS-C), contemporaneous with episodes of Kawasaki disease. We hypothesized a substantial overlap between the 2 and assessed the performance of an MIS-C likelihood score in differentiating inpatients with nonsevere MIS-C from prepandemic incomplete Kawasaki disease (iKD) without coronary involvement.
A retrospective review of inpatient records was conducted; the nonsevere MIS-C cohort (March 2020-February 2021) met the 2023 definition for MIS-C; the iKD cohort (January 2018-January 2019) met the American Heart Association criteria for iKD without coronary involvement. We applied the likelihood score to both cohorts. We estimated the percent of children with iKD who could have met the clinical criteria of the MIS-C, had they presented in 2023.
The 68 children in the nonsevere MIS-C cohort were older (8 vs 4 years, P < .001) than the 28 children in the iKD cohort. Those in the nonsevere MIS-C cohort had higher rates of thrombocytopenia (P < .001) and lymphopenia (P = .021); those in the iKD cohort had higher rates of pyuria (P < .001). Twenty-four (86%) children in the iKD cohort met the 2023 MIS-C definition. The scoring system correctly predicted 71% to 74% children with their respective clinical diagnoses.
Though there was considerable clinical overlap, thrombocytopenia, lymphopenia, and the absence of pyuria were the most helpful parameters to distinguish children with nonsevere MIS-C from those with iKD.
在2019冠状病毒病大流行期间，炎症综合征的特征描述因儿童多系统炎症综合征（MIS-C）的识别而变得复杂，MIS-C与川崎病发作同时出现。我们假设这两者之间存在大量重叠，并评估了MIS-C可能性评分在区分非重症MIS-C住院患者与无冠状动脉受累的大流行前不完全川崎病（iKD）患者方面的表现。
对住院记录进行回顾性审查；非重症MIS-C队列（2020年3月至2021年2月）符合2023年MIS-C定义；iKD队列（2018年1月至2019年1月）符合美国心脏协会无冠状动脉受累的iKD标准。我们将可能性评分应用于两个队列。我们估计了如果在2023年出现，符合iKD临床标准的儿童中可能符合MIS-C临床标准的百分比。
非重症MIS-C队列中的68名儿童比iKD队列中的28名儿童年龄更大（8岁对4岁，P<.001）。非重症MIS-C队列中的儿童血小板减少症（P<.001）和淋巴细胞减少症发生率更高（P=.021）；iKD队列中的儿童脓尿发生率更高（P<.001）。iKD队列中的24名（86%）儿童符合2023年MIS-C定义。评分系统正确预测了71%至74%儿童的各自临床诊断。
尽管存在相当大的临床重叠，但血小板减少症、淋巴细胞减少症和无脓尿是区分非重症MIS-C儿童与iKD儿童最有用的参数。
