BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new entity affecting a small percentage of children during the COVID-19 pandemic. MATERIALS AND METHODS: Demography, clinical, and laboratory variables of children admitted from April to September 2020 with MIS-C were studied retrospectively at eight hospitals in Delhi, India. RESULTS: We identified 120 patients [median age: 7 years (interquartile range (IQR): 4-10)] with male-to-female ratio of 2.3:1. Overall, 73 out of 120 children (60.8%) presented with shock, 63 (52.5%) required inopressor support, and 51 (43%) required respiratory support. We categorized the cohort into three observed clinical phenotypes: MIS-C with shock (n = 63), MIS-C with Kawasaki disease (KD) (n = 23), and MIS-C without shock and KD (n = 34). Atypical presentations were hypothermia, orchitis, meningoencephalitis, demyelination, polyneuropathy, pancreatitis, and appendicitis. Ninety-four percent had laboratory evidence of SARS-CoV-2 (78.3%, seropositive and 15.8%, RT-PCR positive). The median C-reactive protein (CRP) was 136 mg/L (IQR, 63.5-212.5) and ferritin was 543 ng/mL (IQR, 225-1,127). More than 90% received immunomodulatory therapy (intravenous immunoglobulins and/or steroids) with an excellent outcome (96% survived). CRP and absolute neutrophil count (ANC) were correlated statistically with severity. CONCLUSION: MIS-C data from Delhi are presented. Rising CRP and ANC predict the severe MIS-C. HOW TO CITE THIS ARTICLE: Mehra B, Pandey M, Gupta D, Oberoi T, Jerath N, Sharma R, et al. COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study. Indian J Crit Care Med 2021;25(10):1176-1182.
INTRODUCTION: This study was planned to explore the clinical and hematological profile of febrile neutropenia (FN) in Indian children with focus on correlation of degree of neutropenia with fever and procalcitonin (PCT) level and the utility of serum PCT levels in cases of FN. MATERIALS AND METHODS: Children below 12 years, receiving chemotherapy for hematological malignancy having oral temperature more than 100°F and absolute neutrophil count (ANC) below 500/mm3 were included. The aim of this study was to observe the clinicohematological profile of FN and utility of serum PCT levels in neutropenic patients. PCT was done by two-step two-site electrochemiluminescence immunoassay. Serum PCT values were reported as nanogram/ml. RESULTS: Four categories were made based on serum PCT levels which had negative correlation with ANC but no correlation with microbiologically detected infections. DISCUSSION: PCT is generally used to support the diagnosis of bacterial infection or sepsis in the emergency department or to monitor the treatment of sepsis with regard to reviewing antimicrobial treatment. The use of PCT has been well established as a marker for infection in adults and in nonneutropenic children, but similar data are lacking in pediatric population, more so in children with FN in Indian contexts. This study aims to fulfill this lacuna. CONCLUSION: The higher levels of PCT had a high negative correlation with ANC but low correlation with microbiologically detected infections.
