Laboratory and clinical signs 24h after hospitalisation predict MIS-C in children

Hypotension, abdominal pain, rash, and serum sodium concentration in children in the first 24 hours after hospital admission were indicators of COVID-19-associated multisystem inflammatory syndrome (MIS-C), according to a retrospective chart review analysis. Identifying affected children early is key to the successful management of this dangerous syndrome.

MIS-C is a new syndrome associated with SARS-CoV-2 infection that has been increasingly reported in children. Patients with MIS-C usually present with persistent fever, abdominal pain, vomiting, diarrhoea, skin rash, and mucocutaneous lesions. MIS-C associated with COVID-19 may rapidly progress to hypotension and shock with cardiac and other end-organ injuries. “Clinically, we often found it difficult to separate MIS-C from other common childhood illnesses. To solve this problem, we set out to identify features that are distinctive of our patients with MIS-C and to use those for a prediction model,” said Dr Matthew Clark (Vanderbilt University Medical Center, TN, USA) [1].

In a retrospective chart review of children admitted to Vanderbilt Children´s Hospital between 10 June 2020 and 8 April 2021 and evaluated for MIS-C, the researchers collected standardised clinical and laboratory features within the first 24 hours of presentation in the hospital. The diagnosis of MIS-C was determined by the treatment team service and retrospectively reviewed and confirmed by both a paediatric rheumatologist and a paediatric infectious disease physician. Logistic regression with bootstrapped backward selection was used to identify the most important predictors for MIS-C.

During the study period, 127 children were admitted for evaluation for MIS-C. In 45 patients, the MIS-C diagnosis was confirmed. In the final risk prediction model, researchers identified 4 predictors for MIS-C: hypotension, abdominal pain, a rash of any kind, and hyponatremia. The model showed excellent discrimination with a C-index of 0.90 (95% CI 0.85–0.94).

The authors demonstrated that their clinical diagnostic prediction model has excellent discrimination and could assist clinicians in distinguishing patients with MIS-C from those without. “We are planning to test our model with external and prospective validation, and hopefully, it can be of use for clinicians in the future,” Dr Clark concluded.

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   1. Clark M, et al. A prediction model to distinguish patients with multisystem inflammatory syndrome in children. Abstract L09, ACR Convergence 2021, 3–10 November.

 

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Posted on 14 January 202215 February 2024