Mucocutaneous symptoms at hospital admission may not predict severe MIS-C

Mucocutaneous symptoms among children hospitalized for suspected multisystem inflammatory syndrome in children may not predict a severe course of that syndrome, according to recent findings.

“There are few studies comparing severity of [multisystem inflammatory syndrome in children (MIS-C)] disease with mucocutaneous symptoms, age, race and ethnicity,” Megana Rao, BS, of Indiana University School of Medicine, Indianapolis, and colleagues wrote.

The retrospective cohort study included 66 patients hospitalized for suspected MIS-C between May 13, 2020, and April 21, 2021. Rao and colleagues aimed to describe mucocutaneous symptoms exhibited by the patients at initial hospital admission and determine whether such symptoms can predict more severe MIS-C course.

Results showed that 84.8% of the cohort had mucocutaneous findings on admission, of which rash was the most commonly reported (n = 42). Conjunctivitis occurred in 39 patients, whereas cracked lips (n = 21) and sore throat (n = 15) were also common.

The median age of children with mucocutaneous symptoms was 9.8 years, whereas those without these symptoms had a median age of 11.4 years.

Both the mucocutaneous and nonmucocutaneous groups were comparable in terms of pediatric intensive care unit admission, abnormal cardiology study results and necessity of pressors.

Patients with mucocutaneous symptoms at hospital admission were more likely to have lower troponin levels (median, 0.08 ng/mL vs. 0.52 ng/mL; P = .003).

Severe MIS-C was observed more commonly in Black children vs. white children (OR = 3.3; 95% CI, 1.02-10.72).

In addition, severe MIS-C occurred more frequently in children aged 5 years and older than in children aged younger than 5 years (OR = 5.43; 95% CI, 1.39-21.23).

Ultimately, while patients with mucocutaneous symptoms were more likely to have elevated inflammatory markers such as erythrocyte sedimentation rate, D-dimer, ferritin and C-reactive protein, there was no association between mucocutaneous outcomes and severe MIS-C.

Limitations of the study include a small sample size, the lack of dermatologist at hospital admission and variability of diagnostic protocols from center to center.

“The presence of mucocutaneous symptoms negatively correlated with troponin levels, but there was no significant association between these symptoms and other markers of cardiac involvement (echocardiogram, ejection fraction, electrocardiogram),” the researchers concluded.