Frontiers in Pediatrics (May 2023)

Characteristics and outcomes of multisystem inflammatory syndrome in children: A multicenter, retrospective, observational cohort study in Mexico

  • Marco Antonio Yamazaki-Nakashimada,
  • Horacio Márquez-González,
  • Guadalupe Miranda-Novales,
  • Gonzalo Antonio Neme Díaz,
  • Sandhi Anel Prado Duran,
  • Antonio Luévanos Velázquez,
  • Maria F. Castilla-Peon,
  • Nadia González-García,
  • Miguel Alejandro Sánchez Duran,
  • Martha Patricia Márquez Aguirre,
  • Miguel Angel Villasis-Keever,
  • Ranferi Aragón Nogales,
  • Juan Carlos Núñez-Enríquez,
  • Maria Elena Martinez Bustamante,
  • Carlos Aguilar Argüello,
  • Jesús Ramírez de los Santos,
  • Alejandra Pérez Barrera,
  • Lourdes Anais Palacios Cantú,
  • Jesús Membrila Mondragón,
  • Paloma Vizcarra Alvarado,
  • Rodolfo Norberto Jiménez Juárez,
  • Víctor Olivar López,
  • Roberto Velasco-Segura,
  • Adrián López Chávez

DOI
https://doi.org/10.3389/fped.2023.1167871
Journal volume & issue
Vol. 11

Abstract

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IntroductionMultisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death.MethodsThis multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression.ResultsThe study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4–2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8–31.0), platelet count <150,000 /mm3 (OR: 4.2, 95% CI: 1.2–14.7), international normalized ratio >1.2 (OR: 3.8, 95% CI: 1.05–13.9), and serum ferritin concentration >1,500 mg/dl at admission (OR: 52, 95% CI: 5.9–463) were risk factors for death.DiscussionMortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases.

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