Severity predictors for multisystemic inflammatory syndrome in children after SARS-CoV-2 infection in Vietnam
Dien Minh Tran, Dem. V. Pham, Tung. V. Cao, Canh Ngoc Hoang, Ha. T. T. Nguyen, Giang. D. Nguyen, Cuong Nguyen Le, Quan. Q. Thieu, Ta Anh Tuan, Hung. V. Dau, Chi Quynh Le, Quang Le, N. Luong, Mai T. Tran, Phu. H. Nguyen, Nhung. T. Nguyen, Phuc. H. Phan
Abstract
Abstract Multisystemic inflammatory syndrome in children (MIS-C) might manifest in a broad spectrum of clinical scenarios, ranging from mild features to multi-organ dysfunction and mortality. However, this novel entity has a heterogenicity of data regarding prognostic factors associated with severe outcomes. The present study aimed to identify independent predictors for severity by using multivariate regression models. A total of 391 patients (255 boys and 136 girls) were admitted to Vietnam National Children’s Hospital from January 2022 to June 2023. The median age was 85 (range: 2–188) months, and only 12 (3.1%) patients had comorbidities. 161 (41.2%) patients required PICU admission, and the median PICU LOS was 4 (2–7) days. We observed independent factors related to PICU admission, including CRP $$\ge $$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>≥</mml:mo> </mml:math> 50 (mg/L) (OR 2.52, 95% CI 1.39–4.56, p = 0.002), albumin $$\le $$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>≤</mml:mo> </mml:math> 30 (g/L) (OR 3.18, 95% CI 1.63–6.02, p = 0.001), absolute lymphocyte count $$\le $$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>≤</mml:mo> </mml:math> 2 (× 10 9 /L) (OR 2.18, 95% CI 1.29–3.71, p = 0.004), ferritin ≥ 300 (ng/mL) (OR 2.35, 95% CI 1.38–4.01), p = 0.002), and LVEF < 60 (%) (OR 2.48, 95% CI 1.28–4.78, p = 0.007). Shock developed in 140 (35.8%) patients, especially for those decreased absolute lymphocyte $$\le $$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>≤</mml:mo> </mml:math> 2 (× 10 9 /L) (OR 2.48, 95% CI 1.10–5.61, p = 0.029), albumin $$\le $$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>≤</mml:mo> </mml:math> 30 (g/L) (OR 2.53, 95% CI 1.22–5.24, p = 0.013), or LVEF < 60 (%) (OR 2.24, 95% CI 1.12–4.51, p = 0.022). In conclusion, our study emphasized that absolute lymphocyte count, serum albumin, CRP, and LVEF were independent predictors for MIS-C severity. Further well-designed investigations are required to validate their efficacy in predicting MIS-C severe cases, especially compared to other parameters. As MIS-C is a new entity and severe courses may progress aggressively, identifying high-risk patients optimizes clinicians' follow-up and management to improve disease outcomes.