Clinico-Laboratory Profile, Intensive Care Needs and Short-Term Outcome of Multisystem Inflammatory Syndrome in Children (Mis-C): Experience during First and Second Waves from India

ABSTRACT

BACKGROUND AND AIM: The multisystem inflammatory syndrome in children (MIS-C) is a new entity and needs data to study its evolution. To describe the clinicolaboratory profile, intensive care needs, and outcome of MIS-C during the first and second waves. METHOD(S) Retrospective analysis of 122 children with MIS-C admitted to Pediatric emergency and PICU of a tertiary-teaching hospital during first and second wave of Covid-19. RESULT(S) Median (IQR) age was 7 (4-10) years with 67% boys. Common manifestations included fever (99%), abdominal symptoms (81%), rash (66%), conjunctival injection (65%), oral mucosa and respiratory involvement (43% each). Elevated CRP (97%), D-dimer (89%), procalcitonin (80%), IL-6 (78%), ferritin (56%), NT-pro- BNP (84%), and positive SARS-CoV-2 antibody (81%) were common laboratory abnormalities. Cardiovascular manifestations included myocardial dysfunction (55%), shock (48%), and coronary artery changes (10%). The treatment included intensive care support (57%), non-invasive (33%) and invasive (18%) ventilation, vasoactive drugs (47%), IVIG (83%), steroids (85%), and aspirin (87%). Mortality was 5% (n=6). Duration of hospital stay was 5 (3-8) days. During second wave, significantly higher proportion had positive SARS-CoV-2 antibody, contact with COVID-19 case, and oral mucosal changes;lower markers of inflammation (CRP, procalcitonin, ferritin, and IL-6);lower rates of shock, myocardial dysfunction, and coronary artery changes;lesser need of PICU, vasoactive drugs, and IVIG;and shorter hospital stay. CONCLUSION(S) MIS-C is febrile multisystemic disease characterized by hyperinflammation, cardiovascular involvement, relationship to SARS-CoV-2, and good outcome with immunomodulation and intensive care. During the second wave, the severity of illness, degree of inflammation, and intensive care needs was lesser.