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Multicenter Study
. 2023 Aug;94(2):730-737.
doi: 10.1038/s41390-023-02518-0. Epub 2023 Feb 22.

Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study

Guntulu Sık  1 , Aysegul Inamlık  2 , Nihal Akçay  3 , Selman Kesici  4 , Fatih Aygun  5 , Tanıl Kendırlı  6 , Gurkan Atay  7 , Ozlem Sandal  8 , Fatih Varol  9 , Pınar Yazıcı Ozkaya  10 , Muhterem Duyu  11 , Ahmet Ziya Bırbılen  12 , Serhan Ozcan  13 , Gazi Arslan  14 , Murat Kangın  15 , Suleyman Bayraktar  16 , Umit Altug  17 , Ayşe Berna Anıl  18 , Merve Havan  19 , Ayse Filiz Yetımakman  20 , Tahir Dalkıran  21 , Neslihan Zengın  22 , Arzu Oto  23 , Hasan Serdar Kıhtır  24 , Feyza İnceköy Gırgın  25 , Leyla Telhan  26 , Dincer Yıldızdas  27 , Nazik Yener  28 , Ufuk Yukselmıs  29 , Mehmet Alakaya  30 , Mehmet Arda Kılınc  31 , Mehmet Celegen  32 , Adem Dursun  33 , Fatih Battal  34 , Ferhat Sarı  35 , Murat Ozkale  36 , Sevgi Topal  37 , Celebi Kocaoglu  38 , Abdullah Yazar  39 , Nuri Alacakır  40 , Caglar Odek  41 , Ayhan Yaman  42 , Agop Cıtak  2 ; Turkish MIS-C Study Group
Collaborators, Affiliations
Multicenter Study

Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study

Guntulu Sık et al. Pediatr Res. 2023 Aug.

Abstract

Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit.

Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome.

Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation.

Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.

Impact: MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Leukocyte, lactate and ferritine levels on admission.
ROC curves of leukocyte, lactate and ferritin on admission.
Fig. 2
Fig. 2. Max lactate and ferritin levels.
ROC curves of max lactate and ferritin levels.
See this image and copyright information in PMC

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Supplementary concepts