Clinical Features of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 in Indonesia

Abstract

Background: While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia.

Methods: This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021.

Results: The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors.

Conclusions: Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.

Keywords: COVID-19; Indonesia; MIS-C; children.

Fig. 1.

Total COVID-19 cases in relation to MIS-C cases relative to total COVID-19 cases in Cipto Mangunkusumo Hospital.

Fig. 2.

Graphical representation of patients with MIS-C who survived. Antivirals used in this study were favipiravir and lopinavir–ritonavir. MIS-C, multisystem inflammatory syndrome in children; IVIG, intravenous immunoglobulin.

Fig. 3.

Graphical representation of patients with MIS-C who did not survive. MIS-C, multisystem inflammatory syndrome in children.

Fig. 4.

Comparison of clinical features between MIS-C survivors and non-survivors. The squared boxes represent medians while the two extremes of the dotted lines represent the range.