CLINICAL PROFILE AND OUTCOME OF CHILDREN ADMITTED WITH COVID-19 RELATED MULTISYSTEM INFLAMMATORYSYNDROMEINCHILDREN(MIS-C):A HOSPITAL-BASED RETROSPECTIVE COHORT STUDY

Background: Multi-system Inflammatory Syndrome in Children (MIS-C) is an extremely rare but dangeroushyper-inflammatorydiseaselinkedto COVID-19infectionthatresultsinfever, gastrointestinalandskin/mucous membranesymptomsandisalsoaccompaniedbycardiovascularissuessuchasshockandmyocarditis.[1,2]Below arethedemographicdata,clinicalmanifestations,treatmentsandclinicaloutcomesofthechildrendiagnosedwith MIS-Cwhowereadmittedtoourtertiaryhospital.MaterialsandMethods:Themedicalfilesofallchildrenunder theageof18whomettheWorldHealthOrganization(WHO)criteriaforMIS-Cadmittedatourtertiaryhospital between2020–2021wereretrospectivelyexamined.Informationregardingdemographics,clinicalmanifestations, laboratoryandechocardiographictests,treatmentsandclinicaloutcomeswerecollectedfromthefiles.Statistical analysis wasperformed withSPSSversion20.Differences amongcategoricalvariables werecalculated withthe chi-square (χ²) test or Fisher's exact test and differences among continuous variables were tested with Student t-tests or Mann-Whitney U tests. Because of the number of statistical tests, a Bonferonni adjustment for multiple comparisons was made. Results: A total of forty patients (62.5% males) were evaluated (mean age 8.16 ± 2.62 years).Mostpatients(nearly90%)experiencedfever,andgastrointestinalsymptoms(e.g.,abdominalpain, vomiting,diarrhea).Commonlyobservedmucocutaneoussigns(e.g.,rash=50%,oralchanges=45%,conjunctivitis=47.5%)andlymphadenopathyoccurredcommonly.Eightpatients(20%)developedshock (cardiogenic/vasoplegic),andninepatients(22.5%)developedmyocarditis.Themeanagesofpatientsdeveloping shockandmyocarditisdidnotdiffer(p>0.05).However,patientswithshockhadhigherlevelsofcardiactroponin andN-terminalprob-typenatriureticpeptide(NT-proBNP)thannon-shockpatients(meantroponinlevel1.04vs. 0.12ng/mL,p=0.003).Echocardiographicabnormalitieswerepresentin47.5%ofthepatientsoverall;six(15%) patientshadcoronaryarterydilationorectasia.Elevenpatients(27.5%)requiredinotropicsupportandthree (7.5%)patientsrequiredmechanicalventilation.Intensivecareunitadmissionwasnecessaryforseventeen (42.5%)patients.Immunotherapywasuniversallyadministered:95%receivedaspirin,50%receivedintravenous immunoglobulin(IVIG),and75%receivedcorticosteroids(37.5%weregivenpulsedosesteroids).Thirtypercent of the patients received both IVIG and steroid therapy. Patients who developed shock were more likely to have been treated with IVIG (100% vs. 37.5%, p = 0.006) and with combined IVIG and steroid therapy (87.5% vs.15.6%,p