Multisystem inflammatory syndrome in children associated with <scp>COVID</scp>‐19 in 101 cases from Turkey (<scp>Turk‐MISC</scp> study)
Dilek Yılmaz Çiftdoğan, Yıldız Ekemen Keleş, Adem Karbuz, Benhur Şirvan Çetin, Şefika Elmas Bozdemir, Eda Kepenekli, Özge Metin Akcan, Arife Özer, Tuğba Erat, Murat Sütçü, Ayşe Büyükçam, Nurşen Belet, Emine Hafize Erdeniz, Nazan Dalgıç, Selda Hançerlı Törün, Selim Öncel, Zerrin Orbak, Özden Türel, Zeynep Gökçe Gayretli Aydın, Ömer Kılıç, Aysun Yahşi, Ahu Kara Aksay, Zeynep Ergenç, Mey Talip Petmezci, Mehmet Burhan Oflaz, Remzi Sarıkaya, Gülçin Otar Yener, Seval Özen, Doruk Gül, Gazi Arslan, Soner Sertan Kara, Demet Demirkol, Pınar Yazıcı, Yılmaz Yozgat, Celal Varan, Manolya Kara, Gül Arga, Nurhayat Yakut, Ahmet Osman Kılıç, Özlem Akın Çakıcı, Mehmet Küçük, Özge Kaba, Hatice Karaoğlu Asrak, Burcu Bursal Duramaz, Tahir Dalkıran, Ayşe Berna Anıl, Mehmet Turğut, Bülent Karapınar, Ayper Somer, Ferhan Elmalı, Ener Çağrı Dinleyici, Ergi̇n Çi̇ftçi̇, Ateş Kara
Abstract
AIM: Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey. METHODS: The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis. RESULTS: The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6-9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112-228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30-84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58-20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died. CONCLUSION: The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.