Background/Purpose: Multisystem Inflammatory Syndrome in Children (MIS-C) is a post-infectious complication of COVID-19 infection with overlapping features of Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS). In April 2020, a provincial multidisciplinary working group was developed expeditiously in anticipation of emerging MIS-C cases following the first wave of COVID-19 infections. The clinical characteristics of children evaluated for MIS-C in British Columbia are presented.

Methods: We included all children evaluated for MIS-C at British Columbia Children’s Hospital, a provincial quaternary care centre, from May 2020 to April 2021. We developed an evidence based guideline adopting the World Health Organization MIS-C case definition. We prospectively collected patient demographics, clinical and laboratory characteristics, treatment, and outcomes.

Results: Fifty-two children were included. Median age was 6.0 years (interquartile range [IQR] 2.0-12.5 years) and 53% were female. 11 were diagnosed as confirmed MIS-C cases and 41 were ruled out cases without evidence of an epidemiologic link.

10/11 (91%) MIS-C cases presented with shock and prominent gastrointestinal, conjunctivitis, and mucocutaneous involvement. Common laboratory features included elevated C-reactive protein (CRP), D-Dimer, Troponin, and Brain Natriuretic Peptide (BNP). On echocardiography, 4/11 (36%) had myocardial dysfunction and 3/11 (27%) had coronary artery abnormalities. All patients tested positive for SARS-CoV-2 serology, 7/11 (64%) tested positive for Polymerase Chase Reaction (PCR), and 3/11 (27%) had a PCR-confirmed infection 4-6 weeks prior to admission for MIS-C. 10/11 (91%) received IVIG and intravenous corticosteroids, 5/11 (45%) required inotropic support, and 3/11 (27%) were intubated and ventilated. Median hospital stay was 6 days (IQR 4-9 days) and 7/11 (64%) required ICU admission. There were no deaths.

Of the 41 ruled out cases, diagnoses included KD, TSS, viral infections, bacterial infections, and other new systemic inflammatory syndromes. When compared to ruled out cases, MIS-C patients were more likely to have shock (91% vs 37%, p = 0.002); require ICU admission (64% vs 15%, p = 0.003); have myocardial dysfunction (36% vs 6%, p=0.02); and have higher D-Dimer (3339 vs 2050 mcg FEU/L, p = 0.03), Troponin (0.05 vs 0.0004 mcg/L, p = 0.02), and BNP (384 vs 109 ng/L, p = 0.02). MIS-C cases were also more likely to be treated with IVIG (91% vs 56%; p = 0.02), and corticosteroids (91% vs 37%; p = 0.002).

Conclusion: Our provincial cohort of MIS-C patients were more likely to present with shock and cardiac dysfunction, require ICU admission, and be treated with corticosteroids compared to ruled out cases. Our working group’s evolving process ensured children with features of MIS-C were rapidly identified, had standardized evaluation, and received appropriate treatment in our province.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-of-multisystem-inflammatory-syndrome-in-children-a-provincial-cohort/