Differentiating multisystem inflammatory syndrome in children: a single-centre retrospective cohort study

• Published in: Archives of disease in childhood 2022-03, Vol.107 (3), p.e3-e3
• Main Authors: Roberts, Jordan E, Campbell, Jeffrey I, Gauvreau, Kimberlee, Lamb, Gabriella S, Newburger, Jane, Son, Mary Beth, Dionne, Audrey
• Format: Article
• Language: English
• Subjects: Abdominal Pain - etiology; Abscesses; Adolescent; Age of Onset; Autoimmune diseases; Bacterial infections; Bacterial Infections - diagnosis; C-reactive protein; C-Reactive Protein - metabolism; Calcium-binding protein; cardiology; Child; Child, Preschool; Children; Cohort analysis; Conjunctivitis; Conjunctivitis - etiology; Coronaviruses; COVID-19; COVID-19 - blood; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - pathology; Cytomegalovirus; Definitions; Diagnosis, Differential; Electronic cigarettes; epidemiology; Ethnicity; Female; Ferritin; Fever; Hemoglobin; Hospitals; Humans; Hypotension; Hypotension - etiology; Inflammation; Kawasaki disease; Laboratories; Leukocyte Count; Leukocytes (neutrophilic); Lymphadenitis; Lymphadenitis - diagnosis; Lymphocyte Count; Lymphocytes; Lymphopenia; Male; Medical Evaluation; Medical laboratories; microbiology; Mouth Mucosa - pathology; Mucosa; Multisystem inflammatory syndrome in children; Neutrophils; Original Research; Pain; Patients; Pediatrics; Peptides; Physical Examinations; Platelet Count; Platelets; Proteins; Retrospective Studies; Rheumatology; Severe acute respiratory syndrome coronavirus 2; Systemic Inflammatory Response Syndrome - blood; Systemic Inflammatory Response Syndrome - complications; Systemic Inflammatory Response Syndrome - diagnosis; Systemic Inflammatory Response Syndrome - pathology; Thrombocytopenia; Troponin; Ultrasonic imaging; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - diagnosis; Urogenital system; Viral infections; Virus Diseases - diagnosis
• ISSN: 0003-9888; 1468-2044; 1468-2044
• DOI: 10.1136/archdischild-2021-322290

ObjectiveFeatures 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 designWe 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.ResultsWe 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.ConclusionsAmong 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.