COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study

Bharat Mehra; Mukul Pandey; Dhiren Gupta; Tania Oberoi; Nameet Jerath; Rachna Sharma; Naresh Lal; Chandrasekhar Singha; Bhavana Malhotra; Vinamra Manocha; Ashish K Simalti; Yogesh Arya; Sandeep K Dugaya; Swati Kalra; Amar J Chitkara; Anil Sachdev; Neeraj Gupta

doi:10.5005/jp-journals-10071-23996

COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study

Indian J Crit Care Med. 2021 Oct;25(10):1176-1182. doi: 10.5005/jp-journals-10071-23996.

Authors

Bharat Mehra¹, Mukul Pandey², Dhiren Gupta³, Tania Oberoi⁴, Nameet Jerath⁴, Rachna Sharma⁵, Naresh Lal⁵, Chandrasekhar Singha⁶, Bhavana Malhotra³, Vinamra Manocha⁷, Ashish K Simalti⁸, Yogesh Arya⁶, Sandeep K Dugaya⁹, Swati Kalra¹⁰, Amar J Chitkara⁹, Anil Sachdev³, Neeraj Gupta³

Affiliations

¹ Department of Pediatric Intensive Care, Max Super Speciality Hospital, New Delhi, India.
² Department of Pediatrics, St Stephens Hospital, New Delhi, India.
³ Department of Pediatric Intensive Care, Sir Ganga Ram Hospital, New Delhi, India.
⁴ Department of PICU, Apollo Hospital, New Delhi, India.
⁵ Department of Pediatric Critical Care, BLK Super Speciality Hospital, New Delhi, India.
⁶ Department of PICU, Madhukar Rainbow Children's Hospital, New Delhi, India.
⁷ Department of Pediatrics, Mata Chanan Devi Hospital, New Delhi, India.
⁸ Department of Pediatric Critical Care, Military Hospital, Dehradun, Uttarakhand, India.
⁹ Department of Pediatrics, Max Super Speciality Hospital, New Delhi, India.
¹⁰ Department of Pediatrics, Baba Saheb Ambedkar Hospital, New Delhi, India.

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new entity affecting a small percentage of children during the COVID-19 pandemic.

Materials and methods: Demography, clinical, and laboratory variables of children admitted from April to September 2020 with MIS-C were studied retrospectively at eight hospitals in Delhi, India.

Results: We identified 120 patients [median age: 7 years (interquartile range (IQR): 4-10)] with male-to-female ratio of 2.3:1. Overall, 73 out of 120 children (60.8%) presented with shock, 63 (52.5%) required inopressor support, and 51 (43%) required respiratory support. We categorized the cohort into three observed clinical phenotypes: MIS-C with shock (n = 63), MIS-C with Kawasaki disease (KD) (n = 23), and MIS-C without shock and KD (n = 34). Atypical presentations were hypothermia, orchitis, meningoencephalitis, demyelination, polyneuropathy, pancreatitis, and appendicitis. Ninety-four percent had laboratory evidence of SARS-CoV-2 (78.3%, seropositive and 15.8%, RT-PCR positive). The median C-reactive protein (CRP) was 136 mg/L (IQR, 63.5-212.5) and ferritin was 543 ng/mL (IQR, 225-1,127). More than 90% received immunomodulatory therapy (intravenous immunoglobulins and/or steroids) with an excellent outcome (96% survived). CRP and absolute neutrophil count (ANC) were correlated statistically with severity.

Conclusion: MIS-C data from Delhi are presented. Rising CRP and ANC predict the severe MIS-C.

How to cite this article: Mehra B, Pandey M, Gupta D, Oberoi T, Jerath N, Sharma R, et al. COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study. Indian J Crit Care Med 2021;25(10):1176-1182.

Keywords: Corticosteroids; Hyperinflammation; Intravenous Immunoglobulin—IVIG; Kawasaki disease; Multisystem inflammatory syndrome in children (MIS-C); SARS-CoV-2.