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COVID-19 associated multisystemic inflammatory syndrome in 614 children with and without overlap with Kawasaki disease-Turk MIS-C study group.
Yilmaz Ciftdogan, Dilek; Ekemen Keles, Yildiz; Cetin, Benhur Sirvan; Dalgic Karabulut, Nazan; Emiroglu, Melike; Bagci, Zafer; Buyukcam, Ayse; Erdeniz, Emine Hafize; Arga, Gul; Yesil, Edanur; Cakici, Ozlem; Karbuz, Adem; Sahbudak Bal, Zumrut; Kara, Soner Sertan; Ozer, Arife; Metin Akcan, Ozge; Elmas Bozdemir, Sefika; Anil, Ayse Berna; Uygun, Hatice; Kilic, Omer; Hancerli Torun, Selda; Umit, Zuhal; Sutcu, Murat; Ozgokce Ozmen, Berfin; Karaoglu Asrak, Hatice; Alkan, Gulsum; Kara Aksay, Ahu; Ugur, Cuneyt; Birbilen, Ahmet Ziya; Bursal Duramaz, Burcu; Akyuz Ozkan, Esra; Burakay, Ozgur; Yildirim Arslan, Sema; Karadag Oncel, Eda; Celik, Serkan Fazli; Kilic, Ahmet Osman; Ozen, Seval; Sarikaya, Remzi; Demirkol, Demet; Arslan, Gazi; Turel, Ozden; Sert, Ahmet; Sari, Ergul; Orbak, Zerrin; Sahin, Irfan Oguz; Varan, Celal; Akturk, Hacer; Tuter Oz, Sadiye Kubra; Durak, Fatih; Oflaz, Mehmet Burhan.
  • Yilmaz Ciftdogan D; Izmir Katip Celebi University, Izmir, Turkey.
  • Ekemen Keles Y; Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey.
  • Cetin BS; Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey. kutupylz@hotmail.com.
  • Dalgic Karabulut N; Erciyes University Hospital, Kayseri, Turkey.
  • Emiroglu M; Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
  • Bagci Z; Selcuk University Hospital, Konya, Turkey.
  • Buyukcam A; University of Health Sciences Konya Health Application and Research Center, Konya, Turkey.
  • Erdeniz EH; Gaziantep CG Obstetrics and Children's Hospital, Gaziantep, Turkey.
  • Arga G; Ondokuz Mayis University Hospital, Samsun, Turkey.
  • Yesil E; Ankara University Hospital, Ankara, Turkey.
  • Cakici O; Mersin City Hospital, Mersin, Turkey.
  • Karbuz A; Kocaeli University Hospital, Kocaeli, Turkey.
  • Sahbudak Bal Z; Istanbul Professor Doctor Cemil Tascioglu City Hospital, Istanbul, Turkey.
  • Kara SS; Ege University Hospital, Izmir, Turkey.
  • Ozer A; Aydin Adnan Menderes University, Aydin, Turkey.
  • Metin Akcan O; Van Training and Research Hospital, Van, Turkey.
  • Elmas Bozdemir S; Necmettin Erbakan University, Meram Hospital, Konya, Turkey.
  • Anil AB; Bursa Dortcelik Children's Hospital, Bursa, Turkey.
  • Uygun H; Izmir Katip Celebi University, Izmir, Turkey.
  • Kilic O; Adiyaman University Hospital, Adiyaman, Turkey.
  • Hancerli Torun S; Osmangazi University Hospital, Eskisehir, Turkey.
  • Umit Z; Istanbul University Hospital, Istanbul, Turkey.
  • Sutcu M; Manisa City Hospital, Manisa, Turkey.
  • Ozgokce Ozmen B; Istinye University Hospital, Istanbul, Turkey.
  • Karaoglu Asrak H; Mersin University Hospital, Mersin, Turkey.
  • Alkan G; Dokuz Eylul University Hospital, Izmir, Turkey.
  • Kara Aksay A; Selcuk University Hospital, Konya, Turkey.
  • Ugur C; Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey.
  • Birbilen AZ; University of Health Sciences Konya Health Application and Research Center, Konya, Turkey.
  • Bursal Duramaz B; Gaziantep CG Obstetrics and Children's Hospital, Gaziantep, Turkey.
  • Akyuz Ozkan E; Bezmialem Vakif University Hospital, Istanbul, Turkey.
  • Burakay O; Ondokuz Mayis University Hospital, Samsun, Turkey.
  • Yildirim Arslan S; Kocaeli University Hospital, Kocaeli, Turkey.
  • Karadag Oncel E; Ege University Hospital, Izmir, Turkey.
  • Celik SF; Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey.
  • Kilic AO; Aydin Adnan Menderes University, Aydin, Turkey.
  • Ozen S; Necmettin Erbakan University, Meram Hospital, Konya, Turkey.
  • Sarikaya R; Adiyaman University Hospital, Adiyaman, Turkey.
  • Demirkol D; Van Training and Research Hospital, Van, Turkey.
  • Arslan G; Istanbul University Hospital, Istanbul, Turkey.
  • Turel O; Dokuz Eylul University Hospital, Izmir, Turkey.
  • Sert A; Bezmialem Vakif University Hospital, Istanbul, Turkey.
  • Sari E; Selcuk University Hospital, Konya, Turkey.
  • Orbak Z; Bakirkoy Sadi Konuk Children Hospital, Istanbul, Turkey.
  • Sahin IO; Ataturk University Hospital, Erzurum, Turkey.
  • Varan C; Ondokuz Mayis University Hospital, Samsun, Turkey.
  • Akturk H; Adiyaman University Hospital, Adiyaman, Turkey.
  • Tuter Oz SK; Koc University Hospital, Istanbul, Turkey.
  • Durak F; Selcuk University Hospital, Konya, Turkey.
  • Oflaz MB; Gaziantep CG Obstetrics and Children's Hospital, Gaziantep, Turkey.
Eur J Pediatr ; 181(5): 2031-2043, 2022 May.
Article in English | MEDLINE | ID: covidwho-1669804
ABSTRACT
Multisystemic inflammatory syndrome (MIS-C) diagnosis remains difficult because the clinical features overlap with Kawasaki disease (KD). The study aims to highlight the clinical and laboratory features and outcomes of patients with MISC whose clinical manifestations overlap with or without KD. This study is a retrospective analysis of a case series designed for patients aged 1 month to 18 years in 28 hospitals between November 1, 2020, and June 9, 2021. Patient demographics, complaints, laboratory results, echocardiographic results, system involvement, and outcomes were recorded. A total of 614 patients were enrolled; the median age was 7.4 years (interquartile range (IQR) 3.9-12 years). A total of 277 (45.1%) patients with MIS-C had manifestations that overlapped with KD, including 92 (33.3%) patients with complete KD and 185 (66.7%) with incomplete KD. Lymphocyte and platelet counts were significantly lower in patients with MISC, overlapped with KD (lymphocyte count 1080 vs. 1280 cells × µL, p = 0.028; platelet count 166 vs. 216 cells × 103/µL, p < 0.001). The median serum procalcitonin levels were statistically higher in patients overlapped with KD (3.18 vs. 1.68 µg/L, p = 0.001). Coronary artery dilatation was statistically significant in patients with overlap with KD (13.4% vs. 6.8%, p = 0.007), while myocarditis was significantly more common in patients without overlap with KD features (2.6% vs 7.4%, p = 0.009). The association between clinical and laboratory findings and overlap with KD was investigated. Age > 12 years reduced the risk of overlap with KD by 66% (p < 0.001, 95% CI 0.217-0.550), lethargy increased the risk of overlap with KD by 2.6-fold (p = 0.011, 95% CI 1.244-5.439), and each unit more albumin (g/dl) reduced the risk of overlap with KD by 60% (p < 0.001, 95% CI 0.298-0.559).

CONCLUSION:

Almost half of the patients with MISC had clinical features that overlapped with KD; in particular, incomplete KD was present. The median age was lower in patients with KD-like features. Lymphocyte and platelet counts were lower, and ferritin and procalcitonin levels were significantly higher in patients with overlap with KD. WHAT IS KNOWN • In some cases of MIS-C, the clinical symptoms overlap with Kawasaki disease. • Compared to Kawasaki disease, lymphopenia was an independent predictor of MIS-C. WHAT IS NEW • Half of the patients had clinical features that overlapped with Kawasaki disease. • In patients whose clinical features overlapped with KD, procalcitonin levels were almost 15 times higher than normal. • Lethargy increased the risk of overlap with KD by 2.6-fold in MIS-C patients. • Transient bradycardia was noted in approximately 10% of our patients after initiation of treatment.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Mucocutaneous Lymph Node Syndrome Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Child / Child, preschool / Humans Language: English Journal: Eur J Pediatr Year: 2022 Document Type: Article Affiliation country: S00431-022-04390-2

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Mucocutaneous Lymph Node Syndrome Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Child / Child, preschool / Humans Language: English Journal: Eur J Pediatr Year: 2022 Document Type: Article Affiliation country: S00431-022-04390-2