Predictors of Disease Severity in Children at Riley Hospital with Multisystem Inflammatory Syndrome in Children (MIS-C)

Abstract

AUTHORS: Angela J. Collins, MPH, BS(1); Megana Rao, BS(1); Alka K. Khaitan, MD(2); Samina S. Bhumbra, MD(2)

AFFILIATIONS: (1) Indiana University School of Medicine. (2) Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.

ABSTRACT:

BACKGROUND & OBJECTIVE: Multisystem Inflammatory Syndrome in Children (MIS-C) is a novel condition temporally associated post-SARS-CoV-2-infection. The associated inflammation injures various organs (mainly cardiac and gastrointestinal) and can cause ventricular dysfunction and/or coronary aneurysms, potentially leading to death. This project assessed how lab trends may predict disease outcomes of MIS-C patients at Riley Hospital for Children (RHC).

METHODS: Five lab values (intake procalcitonin, platelet count nadir, absolute lymphocyte count nadir, sodium nadir, troponin-I peak, CRP peak) were assessed as potential predictors of MIS-C severity. Patient demographics (age, sex, race, ethnicity), prior medical history (chronic conditions, obesity), and clinical presentation (days of fever prior to admission) were also assessed as potential predictors of MIS-C severity and lab peaks/nadirs. Indicators of MIS-C severity included PICU admission, length of hospital stay, left ventricular ejection fraction (EF), and abnormal coronary artery findings on echocardiogram. Chi-Square, ANOVA, linear regression, and logistic regression models were completed in SAS9.4 to assess for correlation (α=0.05).

RESULTS: 66 MIS-C patients, aged 9 months to 18 years (mean=8.7 years), were admitted to RHC May 2020-April 2021. 61% were male (n=41). All patients presented with fever. Average length of stay at RHC was 5.9 days. 47% (n=31) were admitted directly to the PICU and 15% (n=10) were transferred to the PICU during their hospital course. Race predicted sodium nadir (p=0.0363), ethnicity predicted intake procalcitonin (p=0.0007), and obesity predicted CRP peak (p=0.0055). Age predicted abnormal EF (p=0.0206) and abnormal coronary outcome on echocardiogram (p=0.0365). Sex and obesity also predicted abnormal coronary outcome on echocardiogram (p=0.0182 and p=0.0478, respectively). Troponin-I peak predicted abnormal EF (p=0.0035) and CRP peak predicted days of hospital stay (p=0.0096).

CONCLUSION & IMPACT: CRP peak is predictive of days of hospital stay and may inform hospital course. Analysis of additional lab values may reveal additional predictors of disease severity to inform clinical care.