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Abstract
Objective Features of multisystem inflammatory syndrome in children (MIS-C) overlap with other febrile illnesses, hindering prompt and accurate diagnosis. The objectives of this study were to identify clinical and laboratory findings that distinguished MIS-C from febrile illnesses in which MIS-C was considered but ultimately excluded, and to examine the diseases that most often mimicked MIS-C in a tertiary medical centre.
Study design We identified all children hospitalised with fever who were evaluated for MIS-C at our centre and compared clinical signs and symptoms, SARS-CoV-2 status and laboratory studies between those with and without MIS-C. Multivariable logistic LASSO (least absolute shrinkage and selection operator) regression was used to identify the most discriminative presenting features of MIS-C.
Results We identified 50 confirmed MIS-C cases (MIS-C+) and 68 children evaluated for, but ultimately not diagnosed with, MIS-C (MIS-C-). In univariable analysis, conjunctivitis, abdominal pain, fatigue, hypoxaemia, tachypnoea and hypotension at presentation were significantly more common among MIS-C+ patients. MIS-C+ and MIS-C- patients had similar elevations in C-reactive protein (CRP), but were differentiated by thrombocytopenia, lymphopenia, and elevated ferritin, neutrophil/lymphocyte ratio, BNP and troponin. In multivariable analysis, predictors of MIS-C included age, neutrophil/lymphocyte ratio, platelets, conjunctivitis, oral mucosa changes, abdominal pain and hypotension.
Conclusions Among hospitalised children undergoing evaluation for MIS-C, children with MIS-C were older, more likely to present with conjunctivitis, oral mucosa changes, abdominal pain and hypotension, and had higher neutrophil/lymphocyte ratios and lower platelet counts. These data may be helpful for discrimination of MIS-C from other febrile illnesses, including bacterial lymphadenitis and acute viral infection, with overlapping features.
- COVID-19
- rheumatology
- cardiology
- epidemiology
- microbiology
Data availability statement
Deidentified data may be made available on reasonable request to the corresponding author. All data access will be subject to a data use agreement and approval by the Boston Children’s Hospital Institutional Review Board.
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Data availability statement
Deidentified data may be made available on reasonable request to the corresponding author. All data access will be subject to a data use agreement and approval by the Boston Children’s Hospital Institutional Review Board.
Footnotes
Twitter @jordanrobertsMD
Contributors JER: Contributed to study conceptualisation and design, collected data, performed analysis, and drafted the initial manuscript, and reviewed and revised the manuscript. JIC: Contributed to study design, data collection, interpretation, and visualisation, and reviewed and revised the manuscript. KG: Oversaw design of statistical analysis plan, performed multivariable analysis, and reviewed and revised the manuscript. GSL: Contributed to data interpretation and reviewed and revised the manuscript. MBS and JN: Contributed to study conceptualisation and design, and reviewed and revised the manuscript. AD: Conceptualised and designed the study, supervised data collection, analysis, and interpretation, and reviewed and revised the manuscript.
Funding Dr Roberts was supported by NIH grant 5T32AI007512-34. Dr Campbell was supported by AHRQ grant number T32HS000063. Drs Dionne and Newburger were supported by The McCance Foundation. Dr Son was supported by the Samara Jan Turkel Center.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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