A retrospective chart review analysis in the first 24 hours after hospital admission revealed four predictors that discriminate between children with multisystem inflammatory syndrome and other syndromes: hypotension, abdominal pain, rash, and serum sodium concentration. Identifying affected children early is key to the successful management of this dangerous syndrome.
Multisystem inflammatory syndrome (MIS-C) is a new syndrome associated with SARS-CoV-2 infection that has been reported in children in increasing numbers. MIS-C associated with COVID-19 may rapidly progress to hypotension and shock with cardiac and other end-organ injuries in affected children. “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).1
In a retrospective chart review of children admitted to Vanderbilt Children´s Hospital between June 10, 2020 and April 8, 2021 and evaluated for MIS-C, the researchers collected standardized clinical, laboratory, and cardiac 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 pediatric rheumatologist and a pediatric infectious disease specialist. 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, the researchers identified four 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.
- Clark M, et al. A prediction model to distinguish patients with multisystem inflammatory syndrome in children. Abstract L09. ACR Convergence 2021, 3– November.
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