Clinical and Epidemiological Characteristics of Multisystem Inflammatory Syndrome in Children amid the COVID-19 Pandemic

ABSTRACT

Purpose. The study of epidemiological and clinical and laboratory features and outcomes of multisystem inflammatory syndrome in children who were hospitalized against the backdrop of the current COVID-19 pandemic. Materials and methods. In 19 months (May 2020 – December 2021) 63 patients with a diagnosis of "Multisystem inflammatory syndrome in children" (MIS-C) associated with COVID-19 were observed in Anesthesiology and Intensive Care departments of the Healthcare Institution "City Children's Infectious Clinical Hospital" in Minsk, Republic of Belarus. MIS-C was diagnosed according to CDC/WHO criteria, 2020. All calculations were carried using the R Statistical Package, version 4.1. The results of the analysis were considered statistically significant with p<0.05. Results. Focusing on the periods of circulation of dominant coronaviruses, we generated 3 groups of patients. The 1st group included 40 patients (63.5%) received treatment from 05.25.2020 to 02.21.2021 ("wuhan" strains);the 2nd group comprised 9 children (14.3%) from 02.23.2021 to 06.13.2021 ("alpha");and the 3rd group consists of 14 children (22.2%) from 07.01.2021 to 11.19.2021 ("delta"). 47 (74.6%) patients had complete and incomplete Kawasaki Disease phenotype of MIS-C;nonspecific phenotype was observed in 16 (25.4%) children. The mean age didn`t differ in study groups. It was 7±2.5;9.4±4.2;7.9±5 years respectively. All children presented hyperthermic syndrome with febrile fever 3–4 times a day of an average duration of 3.2 (1–15) days. Clinically, the course of MIS-C in children was not dependent on the circulating strain of the virus, and gastrointestinal dysfunction was observed with equal frequency in all three groups (73%, 78% and 57%, respectively). The only statistically significant increase in number of children with cheilitis was observed in the 2 group – 8 (89%) and the 3 group – 13 (93%), p=0.002. Neurological disorders such as headache, hyperesthesia, hallucinations, photophobia were more frequently observed in the 1st group of children – 19 (48%) cases, and less frequently in the 2nd and 3rd group (in 11% and 14% of cases), p=0.022. Pathological blood flow regurgitation was the most common disorder (68–71%). Several biochemical markers of inflammation levels, such as C-reactive protein (CRP) and procalcitonin (PCT) were high. CRP levels were 162 mg/l (130;245);130 mg/l (90;160);130 mg/l (106;149) in 1–2–3 study groups, respectively. In children of the 1st group CRP level was significantly higher, p=0.052. PCT level was higher in patients of the 3rd group (4.2 ng/ml (2.4;8.8);3.9 ng/ml (3.2;11.9);8.7 ng/ml (3.4;14.1), respectively, p=0.625). Conclusion. The study revealed no appreciable association between clinical or laboratory features of MIS-C and the dominant circulating strain of SARS-CoV-2 within given time periods. During "alpha" and "delta" strains circulation, only a decrease in the number of patients with neurological disorders and an increase in the frequency of cheilitis were of significant differences, p=0.002. The remaining indicators of organ dysfunction were similar in all three groups of children. There was 1 (1.6%) fatal outcome in our study. © 2022, Professionalnye Izdaniya. All rights reserved.