RISK FACTORS for SEVERE DISEASE COURSE in MULTISYSTEM INFLAMMATORY SYNDROME in CHILDREN (MIS-C)-A MULTICENTER, RETROSPECTIVE STUDY

ABSTRACT

Background: Multisystem Infammatory Syndrome in Children (MIS-C) associated with COVID-19, presents as a cytokine storm with features of Kawasaki disease. Many cases present with shock and require intensive care admission. Objectives: We aimed to identify predictors for severe clinical course of MIS-C as defned by the need for ionotropic support during admission Methods: A retrospective multinational cohort study was conducted. Patients with a diagnosis of MIS-C from 9 Israeli medical centers and one US medical center (Chicago, IL) were included. Demographic, clinical, laboratory and imaging variables during admission and hospitalization were retrieved. Univariate and multivariate regression models were used to assess odds ratio (OR) of ionotropic support need during hospitalization. Results: Overall 100 MIS-C patients were included in the study. Sixty-five patients (65%) were hypotensive, 44% required ionotropic support, and 37% had fnding of Left ventricular dysfunction. Univariate model showed that LVD was associated with the need for ionotropic support (OR 4.178 [95%CI 1.760-9.917], while conjunctivitis (OR 0.403 [95%CI 0.173-0.938]) and mucosal changes (OR 0.333 [95%CI 0.119-0.931]) were protective. Laboratory markers for severe disease course were low hemoglobin levels, leukocyte count, thrombocyte count, lymphocyte count, neutrophils count, albumin and potassium, as well as high troponin and BNP. Conclusion: Patients with MIS-c that present with a Kawasaki-like phenotype are less likely to require ionotropic support, while other clinical and laboratory parameters were found as risk factors and should be monitored during MIS-C hospitalization.