High fevers, left ventricular dysfunction may predict severe MIS-C
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Key risk factors that may predict severe disease in patients with MIS-C include fever greater than 103.1 degrees Fahrenheit, central nervous system involvement and left ventricular dysfunction, according to data published in Rheumatology.
“[Multisystem inflammatory syndrome in children (MIS-C)] may be severe, with some studies reporting a majority of patients presenting with shock, requiring admission to the intensive care unit (ICU) and inotropic support,” Kfir Kaidar, MD, of the rheumatology department at Schneider Children’s Medical Center, in Israel, and colleagues wrote. “Although MIS-C has been described in children from various countries, information is lacking regarding the risk factors that may be associated with a more severe clinical course and outcome.”
To investigate potential predictors of severe disease in patients with MIS-C, Kaidar and colleagues conducted a retrospective study of children who were hospitalized across nine medical centers throughout Israel and one site in Chicago. Inclusion criteria required patients to have been admitted to the ICU with suspected MIS-C between July 2020 and March 2021.
The researchers collected and analyzed data including demographic information, clinical manifestations at the time of presentation, imaging and laboratory findings at the time of hospital admission, and COVID-19 PCR results. For the purposes of the study, severe disease was defined as any disease course that required inotropic support.
The analysis included a total of 100 patients, with an average age of 9.65 years. Among of the included patients, 44 required inotropic support. According to the researchers, left ventricular dysfunction appeared to be linked to severe disease course (OR = 4.178; 95% CI, 1.76-9.917). Meanwhile, conjunctivitis (OR = 0.403; 95% CI, 0.173-0.938) and mucosal changes (OR = 0.333; 95% CI, 0.119-0.931) appeared to be protective against severe disease course.
Laboratory markers that predicted a severe disease course included low hemoglobin, platelets, albumin and potassium values, as well as high amounts of leukocytes, neutrophils, troponin and brain natriuretic peptide.
In the multivariate analysis, central nervous system involvement and a fever measuring greater than 103.1 degrees Fahrenheit were associated with severe disease. Low hemoglobin and platelet count, as well as elevated C-reactive protein and troponin levels were also risk factors for severe disease. Meanwhile, mucosal involvement demonstrated a 6.2-fold lower risk for severe disease.
“The findings of this study may help clinicians to identify clinical and laboratory signs to predict a severe disease course, as reflected by the need for inotropic support,” Kaidar and colleagues wrote. “Identification of patients at high risk to develop a severe disease course may lead to earlier, more aggressive treatment decisions.”
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