Table 1.
Comparison of MIS‐C criteria in the CDC and WHO case definitions as applied by the OC‐19 and BATS Consortium, respectively
| Criterion | CDC MIS‐C case definition as applied to OC‐19 cohort | WHO MIS‐C case definition as applied to BATS cohort |
|---|---|---|
| Hospitalization | Required | Not required |
| No alternative diagnosis | Required | Required |
| Age | Less than 21 years | Less than 20 years |
| Fever (subjective report or temperature ≥38.0°C) | Duration of at least 24 hours | Duration of at least 3 days |
| Laboratory evidence of systemic inflammation | At least one of the following: CRP level ≥0.5 mg/dl, procalcitonin level ≥0.1 ng/ml, erythrocyte sedimentation rate >20 mm/hour, elevated ferritin level, a fibrinogen level >400 mg/dl, D‐dimer level >500 ng/ml, absolute neutrophil count >8000/μl, absolute lymphocyte count <1000/μl | At least one of the following: CRP level ≥0.8 mg/dl, procalcitonin level ≥0.15 ng/ml |
| Evidence of SARS‐CoV‐2 infection | At least one of the following: contact with a case of COVID‐19 within the 4 weeks prior to symptom onset (accepted only for cases reported March 15 to May 31, 2020), positive SARS‐CoV‐2 serology test result, positive SARS‐CoV‐2 RT‐PCR result | At least one of the following: household contact with a confirmed or probable case of COVID‐19, positive SARS‐CoV‐2 serology test result, positive SARS‐CoV‐2 RT‐PCR result |
| Involvement of at least two organ systems or at least two clinical signs of multisystem involvement | ||
| Cardiovascular or cardiac | At least one of the following: troponin levels elevated above hospital‐specific reference range, b BNP or NT‐proBNP level >400 pg/ml, ventricular dysfunction, mitral or aortic regurgitation, pericardial effusion, coronary artery aneurysm, c pericarditis or myocarditis, pulmonary edema due to left heart failure, arrhythmia, cardiac arrest, shock requiring vasopressors | At least one of the following: troponin level >0.014 ng/ml, BNP or NT‐proBNP level >400 pg/ml, left ventricular dysfunction, valvular dysfunction, pericardial effusion, coronary artery aneurysm, d pericarditis or myocarditis, endocarditis e |
| Hypotension or shock | Shock requiring vasopressors included in cardiovascular | Receipt of intravenous fluid bolus e or vasopressors |
| Coagulopathic | Not included | PT ≥14 seconds, INR ≥1.45, aPTT ≥40.4 seconds, or D‐dimer level ≥540 ng/ml |
| Hematologic | At least one of the following: thrombocytopenia, anemia, or leukopenia; venous thromboembolism; hemolysis f ; bleeding f ; ischemia of an extremity f | Not included |
| Gastrointestinal | At least one of the following: diarrhea, vomiting, abdominal pain, nausea or anorexia, f hepatitis, f gallbladder hydrops or edema, f pancreatitis f | At least one of the following: diarrhea, vomiting, abdominal pain |
| Dermatologic or mucocutaneous | At least one of the following: rash or skin ulcers, mucous membrane changes, desquamation, conjunctivitis, peripheral extremity edema, erythema, or discoloration | At least one of the following: rash, mucous membrane changes, desquamation, conjunctivitis |
| Respiratory | At least one of the following: receipt of supplemental oxygen, lower respiratory infection, infiltrates on chest x‐ray, f pleural effusion, f bronchospasm, f pulmonary hemorrhage, f pneumothorax, receipt of chest tube, or thoracentesis f | Not included |
| Renal | Acute kidney injury or receipt of renal replacement therapy | Not included |
| Neurologic | At least one of the following: aseptic meningitis or encephalitis, seizure, stroke or intracranial hemorrhage, coma or unresponsiveness, receipt of neurodiagnostic testing, f decreased vision or hearing, f iritis or uveitis f | Not included |
Abbreviations: aPTT, activated partial thromboplastin time; BATS, Best Available Treatment Study; BNP, brain natriuretic peptide; CDC, US Centers for Disease Control and Prevention; COVID‐19, coronavirus disease 2019; CRP, C‐reactive protein; INR, international normalized ratio; MIS‐C, multisystem inflammatory syndrome in children; NT‐proBNP, N‐terminal pro–brain natriuretic peptide; OC‐19, Overcoming COVID‐19 Public Health Surveillance Registry; PT, prothrombin time; RT‐PCR, reverse transcriptase polymerase chain reaction; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; WHO, World Health Organization.
Female patient aged <6 months: >375 ng/ml; female patient aged ≥6 months: >75 ng/ml; male patient aged <6 years: >75 ng/ml; male patient aged ≥6 years: >320 ng/ml.
Hospital‐specific troponin reference ranges were not collected by the BATS Consortium; a blanket threshold of 0.014 ng/ml was applied.
OC‐19 definition of coronary artery aneurysm: z score ≥2.5 of left anterior descending or right coronary artery.
BATS definition of coronary artery aneurysm: z score ≥2.5 or report of coronary artery aneurysm, excluding isolated left main coronary artery abnormality.
Data element not collected by OC‐19.
Data element not collected by BATS Consortium.