Abstract
Purpose
Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU).
Methods
This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented.
Results
A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5–11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells × μL, platelet count 153 vs. 212 cells × 103/ μL, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 μg/L, ferritin 644 vs. 334 μg/L, all for p< 0.001). Being between ages 5–12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971–8.627] and six times (95% CI 2.575–14.654), respectively, compared to being between the ages 0–5. A one-unit increase in log d-dimer (µg/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079–3.233) and 1.4 times (95% CI 1.133–1.789), respectively.
Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care.
What is Known: • Lymphopenia and thrombocytopenia were an independent predictor factors in patients with MISC who needed to stay in intensive care unit. • The possibility of the need to stay in the intensive care unit in patients with MISC who had Kawasaki disease-like findings was controversial compared with those who did not. | |
What is New: • A one-unit increase log D dimer and log troponin was demonstrated to require for intensive care unit by 1.8 and 1.4 times, respectively. • Serum procalcitonin levels had the best performance to predict stay in the intensive care unit stay. |
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All data and document information are available to give to the European Journal of Pediatrics.
Abbreviations
- COVID-19:
-
Coronavirus disease 2019
- MIS-C:
-
Multisystemic inflammatory syndrome
- KD:
-
Kawasaki disease
- SARS CoV-2:
-
Acute Respiratory Syndrome Coronavirus 2
- ICU:
-
Intensive care unit
- ECMO:
-
Extracorporeal membrane oxygenation
- rt-PCR:
-
Reverse transcription-polymerase chain reaction
- CRP:
-
C-reactive protein
- ROC:
-
Receiver operating characteristic
- AUC:
-
Area under curve
- OR:
-
Odds ratio
- CI:
-
Confidence interval
- ESR:
-
Erythrocyte sedimentation rate
- IQR:
-
Interquartile range
- BNP:
-
Brain natriuretic peptide
- NT-pro-BNP:
-
N-terminal pro-B-type natriuretic peptide
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Acknowledgements
We express our sincere gratitude to all individuals and institutions who have contributed data to this study. Specifically, we recognize the authors and their respective laboratory for collecting the specimens. The sharing of genomic sequences and associated metadata through the GISAID Initiative on which this research is based.
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Drs Yilmaz, Ekemen-Keles, Turel, Dinleyici, Emiroglu, Kocabas, Duramaz, Uğur, Torun, Ciftci, Elmali Dinleyici, Somer, Kuyucu, and A-Kara conceptualized and designed the study, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Celik, Ozdemir, Bayturan, Turel, Erdeniz, Cakici, Taskin, Erbas, Genceli, Sari, Caymaz, Arga, Kizil, Sutcu, Demirbuga, Alkan, Bagci, Dayar, Ozkan, Yilmaz, Akca, Yesil, SS -Kara, Durak, Yasar, Umit, Uygun, Erdem, Buyukcam, Karadag-Oncel, Tuter Oz, Cetin, Anil, Yilmaz, Zengin, Uzuner, Albayrak, Borakay, Topal, Arslan, Yazar, Ozer, Kendirli, M-Kara, Demirkol, Battal, Kosker, Akcan, Kihtir, Gul, Zaraci, Alakaya, Kula, Celik, Petmezci, Evren Kara Aksay, Konca, Sert, Arslan, Bournaun, Tekeli, Bal, Sahin, and Çiftci designed the data collection instruments, collected data, critically reviewed the manuscript for important intellectual content, and revised the manuscript. Drs. Yilmaz, Ekemen Keles, Bal, Sahin, Bayturan, Demir, Erdeniz, Taskin, Erbas, Genceli, Kara Aksay, Akyol, Tanidir, Donmez, Ucar, Torun, Karpuz, Celik, Varan, Oncel, Belet, Duramaz, Ozkan, Burakay, Karadag Oncel, Celik, Kilic, Ozen, Sarikaya, Demirkol, Arslan, Hatipoglu,Dalgic Karabulut, Turgut, Kuyucu, Dinleyici, Ciftci, and A-Kara conceptualized and designed the study, collected data drafted the initial manuscript, reviewed, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content.
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First, a scientific research application permission was obtained from the Ministry of Health of the Republic of Turkey (2022–01-11T08_08_13). Health Sciences University Tepecik Training and Research Hospital Ethics Committee approval was obtained (Date 15/02/2022 number 2022/02–37). Necessary permissions were obtained from the management of other participating hospitals. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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Yilmaz, D., Ekemen Keles, Y., Emiroglu, M. et al. Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study). Eur J Pediatr 182, 5531–5542 (2023). https://doi.org/10.1007/s00431-023-05207-6
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DOI: https://doi.org/10.1007/s00431-023-05207-6