Table 1. MIS-C patient characterization.
| Moderate MIS-C (n = 6) | Severe MIS-C (n = 8) | All (n = 14) | P valuea | |
|---|---|---|---|---|
| Demographics | ||||
| Females, n (%) | 3 (50) | 4 (50) | 7 (50) | 1.000 |
| Age, yr, median (IQR) | 10 (9–11.75) | 10 (7.75–14.25) | 10 (8.25–13.5) | 0.755 |
| Race/ethnicity | ||||
| White/Caucasian, n (%) | 3 (50) | 2 (25) | 5 (35) | 0.514 |
| African/Black, n (%) | 2 (33) | 2 (25) | 4 (28) | |
| Asian/Middle Eastern, n (%) | 1 (16) | 2 (25) | 3 (21) | |
| Other, n (%) | 0 (0) | 2 (25) | 2 (14) | |
| BMI, median (IQR) | 16.4 (16.1–18.1) | 19.1 (16.5–20.6) | 17.8 (16.1–20.3) | 0.491 |
| Admission data | ||||
| ICU stay, median days (IQR) | 2 (1.7–2) | 5.5 (4–7) | 4 (2–6.2) | 0.004 |
| Hospital stay, median days (IQR) | 7.5 (7–8) | 12.5 (9.7–13) | 9 (7.2–12.7) | 0.008 |
| PIM2 score, median (IQR) | 1.3 (1.1–1.6) | 7.9 (7.5–11.8) | 7.3 (1.6–7.9) | 0.002 |
| PRISM score, median (IQR) | 0 (0–2.25) | 3 (1.5–6) | 2 (0–4) | 0.135 |
| pSOFA score, median (IQR) | 0.5 (0–1) | 4.5 (4–6) | 3.5 (1–4.8) | <0.001 |
| Presenting symptoms | ||||
| Fever, median days (IQR) | 6.5 (6–7.7) | 6 (6–6.2) | 6 (6–7) | 0.573 |
| Upper respiratory tract infection, n (%) | 0 (0) | 2 (25) | 2 (14) | 0.186 |
| (Secondary) respiratory distress, n (%) | 0 (0) | 5 (62) | 5 (35) | 0.016 |
| Gastrointestinal, n (%) | 6 (100) | 8 (100) | 14 (100) | 1.000 |
| Abdominal pain, n (%) | 4 (66) | 8 (100) | 12 (85) | 0.078 |
| Vomiting, n (%) | 4 (66) | 5 (62) | 9 (64) | 0.872 |
| Diarrhea, n (%) | 3 (50) | 3 (37) | 6 (42) | 0.640 |
| Myalgia, n (%) | 1 (16) | 2 (25) | 3 (21) | 0.707 |
| Headache, n (%) | 3 (50) | 3 (37) | 6 (42) | 0.640 |
| Encephalopathy, n (%) | 0 (0) | 2 (25) | 2 (14) | 0.186 |
| Kawasaki criteria | ||||
| Incomplete KD, n (%) | 2 (33) | 7 (87) | 9 (64) | 0.036 |
| Complete KD, n (%) | 2 (33) | 0 (0) | 2 (14) | 0.078 |
| Fever ≥5 d, n (%) | 5 (83) | 7 (87) | 12 (85) | 0.825 |
| Extremity changes, n (%) | 2 (33) | 1 (12) | 3 (21) | 0.347 |
| Exanthema, n (%) | 3 (50) | 6 (75) | 9 (64) | 0.334 |
| Non-exudative conjunctivitis, n (%) | 4 (66) | 7 (87) | 11 (78) | 0.347 |
| Lip or mouth changes, n (%) | 4 (66) | 3 (37) | 7 (50) | 0.280 |
| Cervical lymphadenopathy, n (%) | 3 (50) | 2 (25) | 5 (35) | 0.334 |
| Cardiac ultrasound | ||||
| Hyperechogenicity, n (%) | 2 (33) | 1 (12) | 3 (21) | 0.347 |
| Prominent coronaries without dilatation, n (%) | 3 (50) | 1 (12) | 4 (28) | 0.124 |
| Coronary dilatation, n (%) | 0 (0) | 2 (25) | 2 (14) | 0.186 |
| Decreased LV function (FS <25%), n (%) | 0 (0) | 4 (50) | 4 (28) | 0.091 |
| Association with SARS-CoV-2 | ||||
| Previous SARS-CoV-2 contact (suspect or confirmed), n (%) | 5 (83) | 5 (62) | 10 (71) | 0.393 |
| Interval between first contact and onset symptoms, range | 4–6 wk | 11 d–6 wk | 11 d–6 wk | |
| First positive nasopharyngeal SARS-CoV-2 RT-PCR | ||||
| Prior to MIS-C presentation, n (%) | 1 (16) | 1 (12) | 2 (14) | 0.825 |
| At admission, n (%) | 0 (0) | 1 weak positive (Ct 34) (12) | 1 (7) | 0.369 |
| IgG positive (tested during admission) | 5 (83) | 8 (100) | 13 (92) | 0.231 |
| Laboratory markers during admission | ||||
| ESR (max), median (IQR), mm/U | 87 (48–109.5) | 20 (18–29.5) | 42 (20–108) | 0.095 |
| Hb (min), median (IQR), g/dl | 9.3 (8.4–10.2) | 9.2 (8.5–10) | 9.2 (8.3–10.1) | 0.755 |
| WBC (max), median (IQR), × 109/liter | 7.9 (7.86–15.04) | 15.51 (14.83–20.4) | 15.03 (8.8–17.53) | 0.081 |
| Lymphocytes (min), median (IQR), × 109/liter | 0.63 (0.4–0.76) | 0.28 (0.24–0.4) | 0.37 (0.26–0.57) | 0.029 |
| Neutrophils (max), median (IQR), × 109/liter | 6.75 (6.42–10.01) | 13.49 (12.63–17.09) | 12.27 (7.47–14.7) | 0.020 |
| Eosinophils (min), median (IQR), × 109/liter | 0.07 (0.02–0.1) | 0 (0–0.01) | 0.01 (0–0.05) | 0.029 |
| Platelets (min), median (IQR), × 109/liter | 162 (148–189) | 138 (77–192) | 153 (88–193) | 0.662 |
| Creatinine (max), median (IQR), mg/dl | 0.62 (0.54–0.72) | 0.78 (0.53–1.19) | 0.71 (0.53–1.09) | 0.512 |
| Urea (max), median (IQR), mg/dl | 29 (21–48) | 60 (43–76) | 47 (36–68) | 0.056 |
| AST (max), median (IQR), U/liter | 44 (34–60) | 54 (43–94) | 49 (37–70) | 0.445 |
| ALT (max), median (IQR), U/liter | 46 (35–53) | 68 (61–86) | 55 (43–68) | 0.073 |
| GGT (max), median (IQR), U/liter | 45 (27–52) | 75 (55–102) | 55 (44–77) | 0.022 |
| Ferritin (max), median (IQR), µg/liter | 531 (240.5–608.5) | 703 (557.3–885.3) | 592.5 (510.8–858,8) | 0.282 |
| Fibrinogen (max), median (IQR), mg/dl | 606.5 (453.3–757.5) | 660.5 (460–741.8) | 660.5 (452–759.3) | 1.000 |
| D-dimer (max), median (IQR), ng/ml | 2,906 (2,286–3,700) | 3,920 (2,430–4,945) | 3,190 (2,174–4,420) | 0.534 |
| CRP (max), median (IQR), mg/liter | 189.3 (178.3–193.8) | 324.3 (289–390.6) | 286.4 (187.3–376.1) | 0.142 |
| hsTrop (max), median (IQR), pg/ml | 35 (7.5–114.63) | 193 (77–1,980) | 77 (47.2–278.5) | 0.352 |
| NT-proBNP (max), median (IQR), pg/ml | 507 (506–507) | 5,333 (3,142–8,752) | 3,142 (846–7,043) | 0.095 |
| Treatment | ||||
| Low-flow nasal cannula oxygen, n (%) | 0 (0) | 8 (100) | 8 (57) | <0.001 |
| High-flow nasal cannula oxygen, n (%) | 0 (0) | 5 (62) | 5 (35) | 0.016 |
| Mechanical ventilation, n (%) | 0 (0) | 0 (0) | 0 (0) | 1.000 |
| Inotropics, n (%) | 0 (0) | 8 (100) | 8 (57) | <0.001 |
| IVIG, n (%) | 6 (100) | 5 (62) | 11 (78) | 0.091 |
| Corticosteroids, n (%) | 2 (33) | 7 (87) | 9 (64) | 0.036 |
| Combination IVIG and corticosteroids | 2 (33) | 4 (50) | 6 (42) | 0.533 |
| Acetylsalicylic acid, n (%) | 4 (66) | 5 (62) | 9 (64) | 0.872 |
| Antibiotics, n (%) | 6 (100) | 8 (100) | 14 (100) | 1.000 |
| Biologicals, n (%) | 0 (0) | 0 (0) | 0 (0) | 1.000 |
| Outcome | ||||
| Alive at follow-up, n (%) | 6 (100) | 8 (100) | 14 (100) | 1.000 |
| No residual morbidity, n (%) | 0 (0) | 0 (0) | 0 (0) | 1.000 |
Bold and italic text indicates that P values are <0.05 and are considered significant. BMI, body mass index; ESR, erythrocyte sedimentation rate; FS, fractional shortening; Hb, hemoglobin; ICU, intensive care unit; LV, left ventricular; min, minimum; max, maximum; NT-proBNP, N-terminal pro-brain natriuretic peptide; PRISM, pediatric risk of mortality; pSOFA, pediatric sequential organ failure assessment.
a
Chi-square test (two-sided) for categorical variables, Mann–Whitney U for continuous variables, tested between moderate and severe MIS-C.