Differentiating multisystem inflammatory syndrome in children: a single-centre retrospective cohort study

Author:

Roberts Jordan EORCID,Campbell Jeffrey I,Gauvreau Kimberlee,Lamb Gabriella S,Newburger Jane,Son Mary Beth,Dionne Audrey

Abstract

ObjectiveFeatures of multisystem inflammatory syndrome in children (MIS-C) overlap with other febrile illnesses, hindering prompt and accurate diagnosis. The objectives of this study were to identify clinical and laboratory findings that distinguished MIS-C from febrile illnesses in which MIS-C was considered but ultimately excluded, and to examine the diseases that most often mimicked MIS-C in a tertiary medical centre.Study designWe identified all children hospitalised with fever who were evaluated for MIS-C at our centre and compared clinical signs and symptoms, SARS-CoV-2 status and laboratory studies between those with and without MIS-C. Multivariable logistic LASSO (least absolute shrinkage and selection operator) regression was used to identify the most discriminative presenting features of MIS-C.ResultsWe identified 50 confirmed MIS-C cases (MIS-C+) and 68 children evaluated for, but ultimately not diagnosed with, MIS-C (MIS-C-). In univariable analysis, conjunctivitis, abdominal pain, fatigue, hypoxaemia, tachypnoea and hypotension at presentation were significantly more common among MIS-C+ patients. MIS-C+ and MIS-C- patients had similar elevations in C-reactive protein (CRP), but were differentiated by thrombocytopenia, lymphopenia, and elevated ferritin, neutrophil/lymphocyte ratio, BNP and troponin. In multivariable analysis, predictors of MIS-C included age, neutrophil/lymphocyte ratio, platelets, conjunctivitis, oral mucosa changes, abdominal pain and hypotension.ConclusionsAmong hospitalised children undergoing evaluation for MIS-C, children with MIS-C were older, more likely to present with conjunctivitis, oral mucosa changes, abdominal pain and hypotension, and had higher neutrophil/lymphocyte ratios and lower platelet counts. These data may be helpful for discrimination of MIS-C from other febrile illnesses, including bacterial lymphadenitis and acute viral infection, with overlapping features.

Funder

The McCance Foundation

AHRQ

NIH

Samara Jan Turkel Center

Publisher

BMJ

Subject

Pediatrics, Perinatology, and Child Health

Reference29 articles.

1. Centers for Disease Control and Prevention [Internet]. Emergency preparedness and response: health alert network. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 2020 https://emergency.cdc.gov/han/2020/han00432.asp

2. World Health Organization [Internet];Multisystem inflammatory syndrome in children and adolescents temporally related to COVID,2020

3. RCoPaC H . Guidance: paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Available: https://www.rcpch.ac.uk/resources/paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims-guidance [Accessed 28 Mar 2021].

4. Distinct clinical and immunological features of SARS–CoV-2–induced multisystem inflammatory syndrome in children

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