A Comparison of Pediatric Icu Presentation of Mis-C, Kawasaki Disease, Toxic Shock, and Septic Shock

ABSTRACT

INTRODUCTION: With the COVID19 pandemic there has been a rise of Multisystem Inflammatory Syndrome in Children (MIS-C) cases that have similar symptoms to Kawasaki Disease Shock Syndrome (KDSS), Toxic Shock Syndrome (TSS) and Septic Shock (SS). To differentiate between presenting clinical symptoms, laboratory values and vasoactive requirements would aide in the proper early diagnosis of these diseases. METHOD(S) This was a single center retrospective review of MIS-C, KDSS, TS, and SS patients admitted to the PICU. Mann-Whitney U testing compared each patient population to each other using admission laboratory values, VIS, fluid resuscitation, day of illness admitted, and physical exam findings. RESULT(S) SS and TS patients presented earlier to the ICU compared to MIS-C and KDSS (2 and 2 vs 4.5 and 5, p< 0.001). TS had the highest VIS compared to MIS-C (p=0.005), KDSS (p=0.009), and SS (p=0.008). MIS-C was found to utilize the least fluid resuscitation but only found to be different between MIS-C and TS (p< 0.001). MIS-C had the lowest ejection fraction compared to KDSS (p=0.02), TS (p< 0.001), and SS (p< 0.001). MIS-C patients presented with a highest CRP (24.8 mg/dL) but only found to be different from SS (p=0.01). MIS-C appeared to have a lower WBC (11.4 TH/ uL) compared to KDSS (13.3 TH/uL, p=0.004) and TSS (14.4 TH/uL, p=0.04). KDSS was found to have a greater platelet count (249 TH/uL) compared to MIS-C (128 TH/uL, p< 0.001), TSS (169 TH/uL, p=0.003), and SS (186 TH/uL, p=0.03). TSS had the largest presenting INR (1.50) compared to KDSS (1.25, p=0.009), SS (1.25 TH/uL, p =0.04) and MIS-C (1.13 TH/uL, p< 0.001). MIS-C had a lower sodium (132mmmol/L) compared to TSS (135mmol/L, p< 0.0001) and SS (138mmol/L, p< 0.0001). Patients with KDSS were found to have oral and extremity changes compared to MIS-C (p=0.02, p=0.002). KDSS likely had a cervical lymph node on presentation compared to TSS and SS (p=0.03, p=0.02). MIS-C and KDSS were more likely to have conjunctivitis compared to TSS and SS. CONCLUSION(S) MIS-C was found to have a lower WBC, lower sodium, lower ejection fraction, and required less fluid resuscitation. TSS had the highest VIS and had the highest INR. KDSS and MIS-C had more conjunctivitis and presentation than SS and TSS. KDSS had more oral and extremity changes compared to MIS-C.