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Yilmaz D, Ekemen Keles Y, Emiroglu M, Duramaz BB, Ugur C, Aldemir Kocabas B, Celik T, Ozdemir H, Bayturan S, Turel O, Erdeniz EH, Cakici O, Cakmak Taskin E, Erbas İC, Genceli M, Sari EE, Caymaz C, Kizil MC, Sutcu M, Demirbuga A, Alkan G, Bagcı Z, Timurtas Dayar G, Ozkan EA, Tekin Yilmaz A, Akca M, Yesil E, Kara SS, Akturk H, Yasar B, Umit Z, Uygun H, Erdem N, Buyukcam A, Karadag Oncel E, Tuter Oz SK, Cetin HS, Anil AB, Yilmaz R, Zengin N, Uzuner S, Albayrak H, Borakay O, Topal S, Arslan G, Yazar A, Ozer A, Kendirli T, Kara EM, Demirkol D, Battal F, Kosker M, Metin Akcan O, Kihtir HS, Gul D, Zararci K, Alakaya M, Kula N, Celik E, Petmezci E, Evren G, Kara Aksay A, Konca C, Sert A, Arslan D, Bornaun H, Tekeli O, Bal A, Sahin IO, Demir S, Sap F, Akyol MB, Tanidir IC, Donmez YN, Ucar T, Coban S, Arga G, Hancerli Torun S, Karpuz D, Celik SF, Varan C, Elmali F, Oncel S, Belet N, Hatipoglu N, Dalgic Karabulut N, Turgut M, Somer A, Kuyucu N, Dinleyici EC, Ciftci E, Kara A. Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study). Eur J Pediatr 2023; 182:5531-5542. [PMID: 37782350 DOI: 10.1007/s00431-023-05207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU). METHODS This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented. RESULTS A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5-11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells × μL, platelet count 153 vs. 212 cells × 103/ μL, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 μg/L, ferritin 644 vs. 334 μg/L, all for p< 0.001). Being between ages 5-12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971-8.627] and six times (95% CI 2.575-14.654), respectively, compared to being between the ages 0-5. A one-unit increase in log D-dimer (µg/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079-3.233) and 1.4 times (95% CI 1.133-1.789), respectively. Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care. WHAT IS KNOWN • Lymphopenia and thrombocytopenia were an independent predictor factors in patients with MISC who needed to stay in intensive care unit. • The possibility of the need to stay in the intensive care unit in patients with MISC who had Kawasaki disease-like findings was controversial compared with those who did not. WHAT IS NEW • A one-unit increase log D dimer and log troponin was demonstrated to require for intensive care unit by 1.8 and 1.4 times, respectively. • Serum procalcitonin levels had the best performance to predict stay in the intensive care unit stay.
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Affiliation(s)
| | - Yildiz Ekemen Keles
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey.
| | | | | | - Cuneyt Ugur
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | - Talyan Celik
- Canakkale On Sekiz Mart University Hospital, Canakkale, Turkey
| | - Halil Ozdemir
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Ozden Turel
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Emine Ergul Sari
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | - Canan Caymaz
- Başakşehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | | | - Murat Sutcu
- İstinye University Hospital, Istanbul, Turkey
| | | | | | - Zafer Bagcı
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | | | | | | | | | | | | | - Belma Yasar
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Hatice Uygun
- Adıyaman Research and Training Hospital, Adiyaman, Turkey
| | | | - Ayse Buyukcam
- Ankara Gulhane Research and Training Hospital, Ankara, Turkey
| | - Eda Karadag Oncel
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
| | | | | | - Ayse Berna Anil
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
- Pediatric Intensive Care, Health Sciences University Tepecik Training and Research Hospital, Izmir, Izmir, Turkey
| | | | | | - Selcuk Uzuner
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | | | | | - Sevgi Topal
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gazi Arslan
- Dokuz Eylül University Hospital, Izmir, Turkey
| | - Abdullah Yazar
- Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Arife Ozer
- Health Sciences University Van Training and Research Hospital, Van, Turkey
| | - Tanil Kendirli
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
- Pediatric Intensive Care, Ankara University Hospital, Ankara, Turkey
| | | | | | - Fatih Battal
- Canakkale On Sekiz Mart University Hospital, Canakkale, Turkey
| | | | | | | | - Doruk Gul
- İstinye University Hospital, Istanbul, Turkey
| | | | | | - Nilgun Kula
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Elif Celik
- Aydin Adnan Menderes University Hospital, Aydin, Turkey
| | - Ercument Petmezci
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Ahu Kara Aksay
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
| | - Capan Konca
- Adiyaman University Hospital, Adiyaman, Turkey
| | - Ahmet Sert
- Selcuk University Hospital, Konya, Turkey
| | - Derya Arslan
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | - Helen Bornaun
- Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Onur Tekeli
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Alkan Bal
- Celal Bayar University Hospital, Manisa, Turkey
| | | | - Selcan Demir
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Fatih Sap
- Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Mehmet Bedir Akyol
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | | | | | - Tayfun Ucar
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
- Pediatric Cardiology, Ankara University Hospital, Ankara, Turkey
| | - Senay Coban
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gul Arga
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | | | | | - Celal Varan
- Adiyaman University Hospital, Adiyaman, Turkey
| | | | - Selim Oncel
- Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Nevin Hatipoglu
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | - Nazan Dalgic Karabulut
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Ayper Somer
- Istanbul University Hospital, Istanbul, Turkey
| | | | | | - Ergin Ciftci
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ates Kara
- Hacettepe University Hospital, Ankara, Turkey
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Jiang L, Tang K, Irfan O, Li X, Zhang E, Bhutta Z. Epidemiology, Clinical Features, and Outcomes of Multisystem Inflammatory Syndrome in Children (MIS-C) and Adolescents—a Live Systematic Review and Meta-analysis. CURRENT PEDIATRICS REPORTS 2022; 10:19-30. [PMID: 35540721 PMCID: PMC9072767 DOI: 10.1007/s40124-022-00264-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review A multisystem inflammatory condition occurring in children and adolescents with COVID-19 has become increasingly recognized and widely studied globally. This review aims to investigate and synthesize evolving evidence on its clinical characteristics, management, and outcomes in pediatric patients. Recent Findings We retrieved data from PubMed, EMBASE, Cochrane Library, WHO COVID-19 Database, Google Scholar, and preprint databases, covering a timeline from December 1, 2019, to July 31, 2021. A total of 123 eligible studies were included in the final descriptive and risk factor analyses. We comprehensively reviewed reported multisystem inflammatory syndrome in children (MIS-C) cases from published and preprint studies of various designs to provide an updated evidence on epidemiology, clinical, laboratory and imaging findings, management, and short-term outcomes. Latest evidence suggests that African black and non-Hispanic white are the two most common ethnic groups, constituting 24.89% (95% CI 23.30–26.48%) and 25.18% (95% CI 23.51–26.85%) of the MIS-C population, respectively. Typical symptoms of MIS-C include fever (90.85%, 95% CI 89.86–91.84%), not-specified gastrointestinal symptoms (51.98%, 95% CI 50.13–53.83%), rash (49.63%, 95% CI 47.80–51.47%), abdominal pain (48.97%, 95% CI 47.09–50.85%), conjunctivitis (46.93%, 95% CI 45.17–48.69%), vomiting (43.79%, 95% CI 41.90–45.68%), respiratory symptoms (41.75%, 95% CI 40.01–43.49%), and diarrhea (40.10%, 95% CI 38.23–41.97%). MIS-C patients are less likely to develop conjunctivitis (OR 0.27, 95% CI 0.11–0.67), cervical adenopathy (OR 0.21, 95% CI 0.07–0.68), and rash (OR 0.44, 95% CI 0.26–0.77), in comparison with Kawasaki disease patients. Our review revealed that the majority of MIS-C cases (95.21%) to be full recovered while only 2.41% died from this syndrome. We found significant disparity between low- and middle-income countries and high-income countries in terms of clinical outcomes. Summary MIS-C, which appears to be linked to COVID-19, may cause severe inflammation in organs and tissues. Although there is emerging new evidence about the characteristics of this syndrome, its risk factors, and clinical prognosis, much remains unknown about the causality, the optimal prevention and treatment interventions, and long-term outcomes of the MIS-C patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40124-022-00264-1.
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Affiliation(s)
- Li Jiang
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Kun Tang
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Omar Irfan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Xuan Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Enyao Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical, Peking University, Beijing, China
| | - Zulfiqar Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan
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