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Laboratory and clinical signs 24h after hospitalisation predict MIS-C in children

Presented by
Dr Matthew Clark, Vanderbilt University Medical Center, TN, USA
ACR 2021
Hypotension, abdominal pain, rash, and serum sodium concentration in children in the first 24 hours after hospital admission were indicators of COVID-19-associated multisystem inflammatory syndrome (MIS-C), according to a retrospective chart review analysis. Identifying affected children early is key to the successful management of this dangerous syndrome.

MIS-C is a new syndrome associated with SARS-CoV-2 infection that has been increasingly reported in children. Patients with MIS-C usually present with persistent fever, abdominal pain, vomiting, diarrhoea, skin rash, and mucocutaneous lesions. MIS-C associated with COVID-19 may rapidly progress to hypotension and shock with cardiac and other end-organ injuries. “Clinically, we often found it difficult to separate MIS-C from other common childhood illnesses. To solve this problem, we set out to identify features that are distinctive of our patients with MIS-C and to use those for a prediction model,” said Dr Matthew Clark (Vanderbilt University Medical Center, TN, USA) [1].

In a retrospective chart review of children admitted to Vanderbilt Children´s Hospital between 10 June 2020 and 8 April 2021 and evaluated for MIS-C, the researchers collected standardised clinical and laboratory features within the first 24 hours of presentation in the hospital. The diagnosis of MIS-C was determined by the treatment team service and retrospectively reviewed and confirmed by both a paediatric rheumatologist and a paediatric infectious disease physician. Logistic regression with bootstrapped backward selection was used to identify the most important predictors for MIS-C.

During the study period, 127 children were admitted for evaluation for MIS-C. In 45 patients, the MIS-C diagnosis was confirmed. In the final risk prediction model, researchers identified 4 predictors for MIS-C: hypotension, abdominal pain, a rash of any kind, and hyponatremia. The model showed excellent discrimination with a C-index of 0.90 (95% CI 0.85–0.94).

The authors demonstrated that their clinical diagnostic prediction model has excellent discrimination and could assist clinicians in distinguishing patients with MIS-C from those without. “We are planning to test our model with external and prospective validation, and hopefully, it can be of use for clinicians in the future,” Dr Clark concluded.

    1. Clark M, et al. A prediction model to distinguish patients with multisystem inflammatory syndrome in children. Abstract L09, ACR Convergence 2021, 3–10 November.


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