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COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India
OBJECTIVES: To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity. DESIGN: Hospital-based pros...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8523964/ https://www.ncbi.nlm.nih.gov/pubmed/34693035 http://dx.doi.org/10.1136/bmjpo-2021-001195 |
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author | Tiwari, Arun Balan, Suma Rauf, Abdul Kappanayil, Mahesh Kesavan, Sajith Raj, Manu Sivadas, Suchitra Vasudevan, Anil Kumar Chickermane, Pranav Vijayan, Ajay John, Shaji Thomas CK, Sasidharan Krishnan, Raghuram A Sudhakar, Abish |
author_facet | Tiwari, Arun Balan, Suma Rauf, Abdul Kappanayil, Mahesh Kesavan, Sajith Raj, Manu Sivadas, Suchitra Vasudevan, Anil Kumar Chickermane, Pranav Vijayan, Ajay John, Shaji Thomas CK, Sasidharan Krishnan, Raghuram A Sudhakar, Abish |
author_sort | Tiwari, Arun |
collection | PubMed |
description | OBJECTIVES: To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity. DESIGN: Hospital-based prospective cohort study. SETTING: Two tertiary care centres in Kerala, India. PARTICIPANTS: Diagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention. STATISTICAL ANALYSIS: Pearson χ(2) test or Fisher’s exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni’s correction was used for multiple comparisons. RESULTS: We report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes. CONCLUSIONS: Patients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation. |
format | Online Article Text |
id | pubmed-8523964 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-85239642021-10-19 COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India Tiwari, Arun Balan, Suma Rauf, Abdul Kappanayil, Mahesh Kesavan, Sajith Raj, Manu Sivadas, Suchitra Vasudevan, Anil Kumar Chickermane, Pranav Vijayan, Ajay John, Shaji Thomas CK, Sasidharan Krishnan, Raghuram A Sudhakar, Abish BMJ Paediatr Open Immunology OBJECTIVES: To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity. DESIGN: Hospital-based prospective cohort study. SETTING: Two tertiary care centres in Kerala, India. PARTICIPANTS: Diagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention. STATISTICAL ANALYSIS: Pearson χ(2) test or Fisher’s exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni’s correction was used for multiple comparisons. RESULTS: We report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes. CONCLUSIONS: Patients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation. BMJ Publishing Group 2021-10-17 /pmc/articles/PMC8523964/ /pubmed/34693035 http://dx.doi.org/10.1136/bmjpo-2021-001195 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Immunology Tiwari, Arun Balan, Suma Rauf, Abdul Kappanayil, Mahesh Kesavan, Sajith Raj, Manu Sivadas, Suchitra Vasudevan, Anil Kumar Chickermane, Pranav Vijayan, Ajay John, Shaji Thomas CK, Sasidharan Krishnan, Raghuram A Sudhakar, Abish COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India |
title | COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India |
title_full | COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India |
title_fullStr | COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India |
title_full_unstemmed | COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India |
title_short | COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India |
title_sort | covid-19 related multisystem inflammatory syndrome in children (mis-c): a hospital-based prospective cohort study from kerala, india |
topic | Immunology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8523964/ https://www.ncbi.nlm.nih.gov/pubmed/34693035 http://dx.doi.org/10.1136/bmjpo-2021-001195 |
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