SARS-CoV2-associated multisystem inflammatory syndrome in children: data from Khimki hospital

Abstract

Purpose: Multisystem inflammatory syndrome in children (MIS-C) – the most severe status, associated with SARS-COV-2 infection. Clinical and laboratory characteristics of MIS-C, and treatment optimization are topical problems on current stage. Our aim to analyze main features of the MIS-C. Methods & Materials: We evaluated 41 children (21M/18F) 1 - 16 yrs. (8,45±0,677 yrs.) hospitalized in Khimki Regional Hospital with MIS-C from June 2020 to April 2021. 7 children had background disease (allergy, nephroblastoma, ulcerative colitis, diabetes mellitus, urologic pathology). 5 children were mongoloid race (12%). Excessive weight had 27%, according to BMI; 17% had high growth to age. 58% had A(II) blood group, Rh(+)-positive were 74%. Results: All children at the admission had fever more than 3 days. Anti-SARS-COV-2 IgM and IgG had 1 patient, IgG only - 25 (61%); 2 patients were positive SARS-Cov2 RNA in the oropharyngeal swab; 27% had family contact to СOVID-19. By severity 66% children were hospitalized to the ICU. Clinically skin and mucosal signs had 31 (76 %), gastro-intestinal symptoms – 22 (54%), pneumonia – 20 (49%), kidney injury –15 (40%), cardiovascular damage - 10 (24%), CNS –6 (15%). Simultaneous damage of 2 systems had 37% children, 3 – 46%, 4 - 12%, 5 – 1 patient, 6 – 1 patient. 5 cases developed acute kidney injury like hemolytic-uremic syndrome (HUS), as the main MIS-C performance.Laboratory features: increased ESR (Мe 40,0 (IQR 30-50) мм/ч), elevated CRP (Мe 118,9 (IQR 71,5-129,4)), ferritin (Мe 471,0 (IQR 214,08-990,28)), D-dimer (Мe 2,81 (IQR 1,76 – 4,55)), LDH (Мe 594,0 (IQR 511,0-663,0)), CK (Мe 112,0 (IQR 61,35-288,7)), CK-MB (Мe 44,95 (IQR 33,0-80,1)), decreased albumin (Мe 27,4 (IQR 23,0-33,0)). In 76% patients were treated with methylprednisolone pulse, IVIG in 20%, standard doses of corticosteroids – 10%. All children discharged home with recovery. Conclusion: MIS-C is the most severe form of COVID-19 in children. In Khimki Regional Hospital 41 patient were successfully treated. The main features are severe status (66%-ICU), 63% children had 3+ affected systems; the main symptoms are skin and mucosal damage, gastrointestinal signs and headache, high BMI. There were 5 patients with HUS, during SARS-Cov2 associated MIS-C.