Eastern India collaboration on multi-system inflammatory syndrome in children (eicomisc): A multi-centre observational study

ABSTRACT

Background: Few single centre studies from resourcepoor settings have reported about the epidemiology, clinical feature and outcome of multisystem inflammatory syndrome in children (MIS-C). However, larger data from multi-centre studies on the same is lacking including from Indian setting. Methods: This retrospective collaborative study constituted of data collected on MIS-C from five tertiary care teaching hospitals from Eastern India. Children ≤15 years of age with MIS-C as per the WHO criteria were included. Primary outcome was death or LAMA (leaving against medical advice). Results: A total of 134 MIS-C cases were included (median age, 84 months;males constituted 66.7%). Fever was a universal finding. Rash was present in 40%, and conjunctivitis in 71% cases. Gastro-intestinal and respiratory symptoms were observed in 68% and 53% cases, respectively. Co-morbidity was present in 23.9% cases. Shock at admission was noted in 35%, and 27.38% required mechanical ventilation. Nearly 13% children met the primary outcome. The coronary abnormalities got normalized during follow-up in all except in one child. Initial choice of immunomodulation had no effect on the outcomes. Presence of underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia are the factors significantly associated with the occurrence of primary outcome. Conclusions: MIS-C has myriad of manifestations. Underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were associated with the occurrence of primary outcome (death or LAMA). No difference in outcome was noted with either steroid or IVIG or both. Coronary artery abnormalities resolved in nearly all cases.