Determination of Risk Factors for Severe Life-Threatening Course of Multisystem Inflammatory Syndrome Associated with COVID-19 in Children
Ilia S. Avrusin,
Natalia N. Abramova,
Konstantin E. Belozerov,
Gleb V. Kondratiev,
Liudmila V. Bregel,
Olesya S. Efremova,
Alla A. Vilnits,
Julia E. Konstantinova,
Eugenia A. Isupova,
Tatiana L. Kornishina,
Vera V. Masalova,
Eugeniy Yu. Felker,
Olga V. Kalashnikova,
Vyacheslav G. Chasnyk,
Yuriy S. Aleksandrovich,
Mikhail M. Kostik
Affiliations
Ilia S. Avrusin
Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Natalia N. Abramova
Intensive Care Unite Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Konstantin E. Belozerov
Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Gleb V. Kondratiev
Pediatric Oncology Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Liudmila V. Bregel
Department of Pediatrics, Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia
Olesya S. Efremova
Department of Pediatrics, Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia
Alla A. Vilnits
Pediatric Infectious Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Julia E. Konstantinova
The Research Department of Vaccination and Adverse Event Follow Immunization, Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg 197022, Russia
Eugenia A. Isupova
Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Tatiana L. Kornishina
Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Vera V. Masalova
Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Eugeniy Yu. Felker
Intensive Care Unite Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Olga V. Kalashnikova
Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Vyacheslav G. Chasnyk
Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Yuriy S. Aleksandrovich
Intensive Care Unite Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Mikhail M. Kostik
Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a life-threatening condition that often requires intensive care unit (ICU) admission. The aim of this study was to determine risk factors for severe/life-threatening course of MIS-C. The study included 166 patients (99 boys, 67 girls) aged 4 months–17 years (median 8.2 years). The criterion of severity was the fact of ICU admission. To conduct a comparative analysis, MIS-C patients were divided into two groups: patients hospitalized in the ICU (n = 84, 50.6%) and those who did not need ICU admission (n = 82, 49.4%). Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, and neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin, and D-dimer levels. Additionally, the presence of macrophage activation syndrome was higher in patients admitted to the ICU. Conclusion: Nineteen predictors of severe course of MIS-C were found, out of which hepatomegaly, splenomegaly, D-dimer > 2568 ng/mL, troponin > 10 pg/mL were mainly associated with the probability of being classified as early predictors of severe MIS-C requiring ICU admission.
