Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome
Background: Multisystem inflammatory syndrome in children (MIS-C) is a novel disease associated with COVID-19. The COVID-19 epidemic peaked in May 2022 in Taiwan, and we encountered our first case of MIS-C in late May 2022. We aimed to present patients’ clinical manifestations and identify risk fact...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-04-01
|
| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664623004035 |
| _version_ | 1797215975062372352 |
|---|---|
| author | Chi-Hsien Wu Tu-Hsuan Chang Boon-Fatt Tan Jong-Lin Wu Song-Ming Huang Ting-Yu Yen En-Ting Wu Ching-Chia Wang Min-Tai Lin Chun-Yi Lu Luan-Yin Chang Li-Min Huang |
| author_facet | Chi-Hsien Wu Tu-Hsuan Chang Boon-Fatt Tan Jong-Lin Wu Song-Ming Huang Ting-Yu Yen En-Ting Wu Ching-Chia Wang Min-Tai Lin Chun-Yi Lu Luan-Yin Chang Li-Min Huang |
| author_sort | Chi-Hsien Wu |
| collection | DOAJ |
| description | Background: Multisystem inflammatory syndrome in children (MIS-C) is a novel disease associated with COVID-19. The COVID-19 epidemic peaked in May 2022 in Taiwan, and we encountered our first case of MIS-C in late May 2022. We aimed to present patients’ clinical manifestations and identify risk factors for shock. Methods: We included patients diagnosed with MIS-C at two medical centers from May 2022 to August 2022. We separated those patients into two groups according to whether they experienced shock. We collected demographic, clinical manifestation, and laboratory data of the patients and performed statistical analysis between the two groups. Results: We enrolled 28 patients, including 13 (46 %) with shock and 15 (54 %) without shock. The median age was 6.4 years (IQR: 1.9–7.5). In single variable analysis, patients with shock tended to be older, had more neurological symptoms, more conjunctivitis and strawberry tongue, lower lymphocyte count, lower platelet counts, and higher C-reactive protein, higher procalcitonin, higher ferritin, and higher D-dimer levels than those without shock. The area under the ROC curve that used procalcitonin to be the risk factor of shock with MIS-C was 0.815 (95 % CI 0.644 to 0.987). The cutoff value obtained by ROC analysis of procalcitonin was 1.68 ng/mL. With this cutoff, the test characteristics of procalcitonin were as follows: sensitivity 77 %, specificity 93 %, positive predictive value 91 %, negative predictive value 82 %. Multivariable analysis revealed that procalcitonin was the only independent risk factor of shock with MIS-C on admission (OR, 26.00, 95 % CI, 1.01–668.89). Conclusions: MIS-C patients with high initial procalcitonin levels have higher risks of experiencing shock and may need ICU admission. |
| first_indexed | 2024-04-24T11:38:36Z |
| format | Article |
| id | doaj.art-9fd7db5be1e849469eac78dca11b23d9 |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-04-24T11:38:36Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-9fd7db5be1e849469eac78dca11b23d92024-04-10T04:28:32ZengElsevierJournal of the Formosan Medical Association0929-66462024-04-011234496500Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndromeChi-Hsien Wu0Tu-Hsuan Chang1Boon-Fatt Tan2Jong-Lin Wu3Song-Ming Huang4Ting-Yu Yen5En-Ting Wu6Ching-Chia Wang7Min-Tai Lin8Chun-Yi Lu9Luan-Yin Chang10Li-Min Huang11Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, Chi-Mei Medical Center, Tainan, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Corresponding author. Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 8, Chung Shan S. Rd., Taipei 10041, Taiwan.Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Corresponding author. Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 8, Chung Shan S. Rd., Taipei 10041, Taiwan.Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanBackground: Multisystem inflammatory syndrome in children (MIS-C) is a novel disease associated with COVID-19. The COVID-19 epidemic peaked in May 2022 in Taiwan, and we encountered our first case of MIS-C in late May 2022. We aimed to present patients’ clinical manifestations and identify risk factors for shock. Methods: We included patients diagnosed with MIS-C at two medical centers from May 2022 to August 2022. We separated those patients into two groups according to whether they experienced shock. We collected demographic, clinical manifestation, and laboratory data of the patients and performed statistical analysis between the two groups. Results: We enrolled 28 patients, including 13 (46 %) with shock and 15 (54 %) without shock. The median age was 6.4 years (IQR: 1.9–7.5). In single variable analysis, patients with shock tended to be older, had more neurological symptoms, more conjunctivitis and strawberry tongue, lower lymphocyte count, lower platelet counts, and higher C-reactive protein, higher procalcitonin, higher ferritin, and higher D-dimer levels than those without shock. The area under the ROC curve that used procalcitonin to be the risk factor of shock with MIS-C was 0.815 (95 % CI 0.644 to 0.987). The cutoff value obtained by ROC analysis of procalcitonin was 1.68 ng/mL. With this cutoff, the test characteristics of procalcitonin were as follows: sensitivity 77 %, specificity 93 %, positive predictive value 91 %, negative predictive value 82 %. Multivariable analysis revealed that procalcitonin was the only independent risk factor of shock with MIS-C on admission (OR, 26.00, 95 % CI, 1.01–668.89). Conclusions: MIS-C patients with high initial procalcitonin levels have higher risks of experiencing shock and may need ICU admission.http://www.sciencedirect.com/science/article/pii/S0929664623004035COVID-19MIS-CShockProcalcitoninRisk factor |
| spellingShingle | Chi-Hsien Wu Tu-Hsuan Chang Boon-Fatt Tan Jong-Lin Wu Song-Ming Huang Ting-Yu Yen En-Ting Wu Ching-Chia Wang Min-Tai Lin Chun-Yi Lu Luan-Yin Chang Li-Min Huang Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome Journal of the Formosan Medical Association COVID-19 MIS-C Shock Procalcitonin Risk factor |
| title | Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome |
| title_full | Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome |
| title_fullStr | Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome |
| title_full_unstemmed | Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome |
| title_short | Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome |
| title_sort | clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome |
| topic | COVID-19 MIS-C Shock Procalcitonin Risk factor |
| url | http://www.sciencedirect.com/science/article/pii/S0929664623004035 |
| work_keys_str_mv | AT chihsienwu clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT tuhsuanchang clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT boonfatttan clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT jonglinwu clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT songminghuang clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT tingyuyen clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT entingwu clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT chingchiawang clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT mintailin clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT chunyilu clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT luanyinchang clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome AT liminhuang clinicalmanifestationsandriskfactorsofshockinchildrenwithmultisysteminflammatorysyndrome |