538 - Multisystem inflammatory syndrome in children: Single-center experience in a pediatric children’s hospital

Poster Number: 538
Publication Number: 538.327

Diego A. Cruz Vidal, Nationwide Children's Hospital, Columbus, OH, United States; Simon Lee, Nationwide Children's Hospital, Columbus, OH, United States; Stacy P. Ardoin, Nationwide Children's Hospital, Columbus, OH, United States; Meika Eby, Nationwide Children's Hospital, Columbus, OH, United States; Shoghik Akoghlanian, Nationwide Children's Hospital, Columbus, OH, United States; Richard Lisciandro, Nationwide Children's Hospital, Columbus, OH, United States; Amanda D. Sankar, Nationwide Children's Hospital, Columbus, OH, United States; Vilmarie Rodriguez, Nationwide Children's Hospital, Yes, OH, United States; Guliz Erdem, Nationwide Children's Hospital, Columbus, OH, United States

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a novel hyperinflammatory illness following SARS-CoV-2 infection

Objective: To describe the demographic, clinical, and laboratory characteristics of all the children admitted with MIS-C to a pediatric hospital.

Design/Methods: Single-center, retrospective, descriptive study in Nationwide Children’s Hospital of patients < 21 years old admitted with MIS-C between 5/1/2020 and 31/08/2020. In May of 2020 institutional guidelines for the diagnosis of MIS-C were created to standardize clinical and laboratory evaluation at admission (Figure 1). Demographics, laboratory values, clinical outcomes, echocardiographic, and treatment data were reviewed.  Comparisons between patient groups were done by unpaired t-test with Welch correction or chi-square (GraphPad Prism 9.0).

Results:

Results:
Eighty-eight patients were treated with a diagnosis of MIS-C. Most of the patients were male and African American. Most patients received a combination of IVIG, steroids, aspirin, and prophylactic anticoagulation. No mortalities occurred; one patient required ECMO support (Table 1). Laboratory and echocardiographic findings are described in Table 2. 
Clinical outcomes:
The patients with worse outcomes were older (ICU vs non-ICU: 10.05 vs 7.28 p=0.0076; Vasopressor vs non-vasopressors: 10.43 vs 7.51 p=0.0053; Cardiac dysfunction vs non dysfunction: 10.62 vs 7.06 p=0.0007, Coronary involvement vs non-involvement 10.39 vs 7.71 p=0.0258).

ICU admission: higher procalcitonin (ng/mL) levels (Mean: 25.95 vs 6.58; p=0.0197), IL-6 (pg/mL) (400.6 vs 126, p=0.0056), ALT (U/L) (64.18 vs 38.76; p=0.0497), AST (U/L) (77.62 vs 52.96; p=0.0407), and ferritin (ng/mL) (1098 vs 604.6; p=0.033). With lower albumin (g/dL) levels (mean nadir 2.56 vs 2.95; p= < 0.0001).
Vasopressor’s support:  higher CRP (mg/dL) (mean: 21.77 vs 13.87; p=0.0004), procalcitonin (31.23 vs 5.94; p=0.0108), and IL-6 (450.6 vs 140.7; p=0.0114) levels.  With lower initial albumin levels (3.35 vs 3.71; p=0.0063) and albumin nadir (2.56 vs 2.89; p=0.0004).
Cardiac dysfunction:  higher CRP (21.77 vs 13.87; p=0.0004), procalcitonin (25.9 vs 7.86 p=0.0395), fibrinogen (mg/dL) levels (617.6 vs 520.9; p=0.0036), and lower albumin nadir (2.59 vs 2.88; p=0.0048).
Coronary abnormalities: No significant laboratory differences were found.
Conclusion(s): Standardized clinical and laboratory evaluation of children with MIS-C could be useful to predict clinical outcomes.  Sicker patients and patients with cardiac involvement had higher inflammatory markers and lower albumin levels.
Curriculum VitaeCV DC.pdf
Table 1Abbreviations: IgG: Immunoglobulin; PCR: Polymerase chain reaction; PICU: Pediatric intensive care unit; IVIG: Intravenous immunoglobulin.