Journal Article

Mortality Indicators with Clinical Profile of Multisystem Inflammatory Syndrome in Children during SARS-CoV-2 Second Wave in India: A Tertiary Referral Center Experience

Kundu, Chanchal, Kundu, Tirthankar, Sen, Sandipan, Majumder, Srinanda, Biswas, Arnab, Samanta, Moumita

2023

Overview

Summary Background: Post-COVID-19 cases are being reported with features of hyperinflammatory state causing multiple system dysfunctions in previously healthy children. Objectives: To describe clinical characteristics, laboratory, and radiological profile of children affected with COVID-19-related multisystem inflammatory syndrome postsecond wave in India and compare them with respect to adverse outcome. Materials and Methods: This prospective, observational study was conducted in the department of pediatrics of a tertiary care center in Eastern India over a period of 3 months. Demographic data, clinical details, biochemical parameters, and treatment with clinical outcome were recorded. Children who survived the clinical course were compared with those died during hospital stay. Results: Thirty-five children with a median age of 4.8 (3.9) years were included who were admitted between June 16 and September 15, 2021. Only 17.14% had reverse transcription-polymerase chain reaction positivity previously with 77.14% had positive COVID-19 serology. Most common features were fever (100%), edema (68.6%), gastrointestinal (71.4%), mucocuteneous (65.7%), cardiovascular (57.1%), and neurological symptoms (45.7%). Twenty (57.1%) children had shock at presentation. Decreased ejection fraction (<55%) was the most common echocardiographic feature (37.14%) followed by coronary dilatation (20%). Majority (77.14%) of the patients required intensive care with inotrope requirement in 62.86% cases. Forty percent patients were intubated with mean duration of 9.94 (±10.5) days. All patients received methylprednisolone and 76% were given intravenous immunoglobulin. Tocilizumab was used in three patients. Nine patients died (25.7%) with overall median pediatric intensive care unit stay of 13 (14) days. Conclusion: Of the parameters described, we have found shock, heart failure, neurological involvement at presentation, infancy, and laboratory parameters such as C-reactive protein, CPK, D-Dimer, and lactate dehydrogenase were the predictors of mortality.

• Publisher: Medknow Publications & Media Pvt Ltd,Medknow Publications and Media Pvt. Ltd,Medknow Publications & Media Pvt. Ltd,Wolters Kluwer Medknow Publications
• Subject: COVID-19 / Edema / hyperinflammation / India / Intensive care / kawasaki / Lactate dehydrogenase / Monoclonal antibodies / Mortality / Multisystem inflammatory syndrome in children / Observational studies / Original Article / Parameters / Pediatrics / Polymerase chain reaction / Severe acute respiratory syndrome coronavirus 2 / shock