Differentiating multisystem inflammatory syndrome in children: a single-centre retrospective cohort study. Issue 3 (8th July 2021)

• Record Type: Journal Article
• Authors: Roberts, Jordan E; Campbell, Jeffrey I; Gauvreau, Kimberlee; Lamb, Gabriella S; Newburger, Jane; Son, Mary Beth; Dionne, Audrey
• Is Part Of: Archives of disease in childhood. Volume 107:Issue 3(2022)
• Page Start: e3
• Page End: e3
• Publication Date: 2021-07-08
• Subjects: COVID-19 -- rheumatology -- cardiology -- epidemiology -- microbiology; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2021-322290
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objective: Features 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 design: We 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. Results: We 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. Conclusions: Among 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. Abstract : This single centre cohort study identifies clinical and laboratory findings that distinguish multisystem inflammatory syndrome in children (MIS-C) from other febrile illnesses in which MIS-C was considered but ultimately excluded. The most discriminative features of MIS-C included older age, conjunctivitis, oral mucosa changes, abdominal pain and hypotension, higher neutrophil/lymphocyte ratios and lower platelet counts.