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. 2021 Oct;25(10):1176-1182.
doi: 10.5005/jp-journals-10071-23996.

COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study

Bharat Mehra  1 , Mukul Pandey  2 , Dhiren Gupta  3 , Tania Oberoi  4 , Nameet Jerath  4 , Rachna Sharma  5 , Naresh Lal  5 , Chandrasekhar Singha  6 , Bhavana Malhotra  3 , Vinamra Manocha  7 , Ashish K Simalti  8 , Yogesh Arya  6 , Sandeep K Dugaya  9 , Swati Kalra  10 , Amar J Chitkara  9 , Anil Sachdev  3 , Neeraj Gupta  3
Affiliations

COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study

Bharat Mehra et al. Indian J Crit Care Med. 2021 Oct.

Abstract

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.

Keywords: Corticosteroids; Hyperinflammation; Intravenous Immunoglobulin—IVIG; Kawasaki disease; Multisystem inflammatory syndrome in children (MIS-C); SARS-CoV-2.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
Month-wise trend of MIS-C cases during COVID-19 pandemic
Fig. 2
Fig. 2
Organ system involvement of the MIS-C cohort
Fig. 3
Fig. 3
Five-node CART classification model for severity prediction with splits. Orange squares—severe case; blue squares—non-severe cases
See this image and copyright information in PMC

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