Comparison of laboratory features of pediatric multisystem inflammatory syndrome with other invasive febrile diseases
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v33.i4.29808Keywords:
critically ill child, hyperinflammation, lymphopenia, multisystem inflammatory syndrome in children, pediatric inflammatory multisystem syndrome, sepsisAbstract
Introduction: COVID-19 does not seem to affect children as much as adults. However, a new emerging entity associated with COVID-19, called multisystem inflammatory syndrome in children (MIS-C), has been reported. The aim of this study was to compare the laboratory characteristics of children with MIS-C and other invasive febrile diseases.
Methods: A single-center prospective study was conducted in a Pediatric Intensive Care Unit of a university hospital. The same laboratory panel was performed in both groups: C-reactive protein, procalcitonin, erythrocyte sedimentation rate, interleukin-6, N-terminal pro-B-type natriuretic peptide, troponin T, ferritin, activated partial thromboplastin time, prothrombin time, fibrinogen, and lymphocyte count.
Results: Forty-one patients were included, twenty-four in the MIS-C group and seventeen in the non-MIS-C group. MIS-C predominantly affected older children and adolescents (median age 12 years). Lymphopenia was identified in every patient in the MIS-C group. NT-proBNP, troponin T, CRP, ESR, and fibrinogen levels were significantly higher in the MIS-C group. IL-6 levels were similar between the two groups (p=0.745).
Conclusions: Patients with MIS-C had a laboratory profile characterized by elevated cardiac and inflammatory markers, with lymphopenia being a common feature. IL-6 levels should be interpreted with caution for therapeutic decisions in patients with MIS-C, as they are similar to those seen in patients with other febrile diseases.
Downloads
References
Eurosurveillance Editorial Team. Note from the editors: World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern. Euro Surveill. 2020;25(5):2019-2020. doi: https://doi.org/10.2807/1560-7917.ES.2020.25.5.200131e.
Walensky RP, Bunnell R, Layden J, et al. Council of State and Territorial Epidemiologists/CDC Surveillance Case Definition for Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection — United States. Recomm Reports. 2022;71(4).
Singh-Grewal D, Lucas R, McCarthy K, et al. Update on the COVID-19-associated inflammatory syndrome in children and adolescents; paediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2. J Paediatr Child Health. 2020;56(8):1173-1177. doi: https://doi.org/ 10.1111/jpc.15049.
Schlapbach LJ, Andre MC, Grazioli S, et al. Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland. Front Pediatr. 2021;9(May). doi: https://doi.org/10.3389/fped.2021.667507.
Mistry R, Scanlon N, Hibberd J, Fuller F. Early recognition of PIMS-TS: A single centre retrospective review. BMJ Paediatr Open. 2021;5(1):2020-2021. doi: https://doi.org/10.1136/bmjpo-2020-001011.
Williams V, Dash N, Suthar R, et al. Clinicolaboratory Profile, Treatment, Intensive Care Needs, and Outcome of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2: A Systematic Review and Meta-analysis. J Pediatr Intensive Care. 2022;11(01):001-012. doi: https://doi.org/10.1055/s-0040-1719173.
Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395(10237):1607-1608. doi: https://doi.org/10.1016/S0140-6736(20)31094-1.
Cattalini M, Della Paolera S, Zunica F, et al. Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey. Pediatr Rheumatol. 2021;19(1):1-11. doi: https://doi.org/10.1186/s12969-021-00511-7.
Greene AG, Saleh M, Roseman E, Sinert R. Toxic shock-like syndrome and COVID-19: Multisystem inflammatory syndrome in children (MIS-C). Am J Emerg Med. 2020;38(11):2492.e5-2492.e6. doi: https://doi.org/10.1016/j.ajem.2020.05.117.
Yakut N, Yuksel E, Algul M, et al. Comparison of clinical and laboratory features in coronavirus disease 2019 and pediatric multisystem inflammatory syndrome patients. Pediatr Int. 2022;64(1):e14884. doi: https://doi.org/10.1111/ped.14884.
Lee PY, Day-Lewis M, Henderson LA, et al. Distinct clinical and immunological features of SARS–CoV-2–induced multisystem inflammatory syndrome in children. J Clin Invest. 2020;130(11):5942-5950. doi: https://doi.org/10.1172/JCI141113.
Sherkatolabbasieh H, Firouzi M, Shafizadeh S. Evaluation of platelet count, erythrocyte sedimentation rate and C-reactive protein levels in paediatric patients with inflammatory and infectious disease. New Microbes New Infect. 2020;37:2-5. doi: https://doi.org/10.1016/j.nmni.2020.100725.
Yale SH, Bray C, Bell LN, et al. Erythrocyte Sedimentation Rate and C-reactive Protein Measurements and Their Relevance in Clinical Medicine. Wis Med J. 2016;115(6):317-321. https://wmjonline.org/wp-content/uploads/2016/115/6/317.pdf.
Gupta A, Gill A, Sharma M, Garg M. Multi-System Inflammatory Syndrome in a Child Mimicking Kawasaki Disease. J Trop Pediatr. 2021;67(3):1-5. doi: https://doi.org/10.1093/tropej/fmaa060.
McCormick JK, Yarwood JM, Schlievert PM. Toxic Shock Syndrome and Bacterial Superantigens: An Update. Annu Rev Microbiol. 2001;55(1):77-104. doi: https://doi.org/10.1146/annurev.micro.55.1.77.
Sharma C, Ganigara M, Galeotti C, et al. Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison. Nat Rev Rheumatol. 2021;17(12):731-748. doi:10.1038/s41584-021-00709-9.
Singh S, Jindal AK, Pilania RK. Diagnosis of Kawasaki disease. Int J Rheum Dis. 2018;21(1):36-44. doi: https://doi.org/10.1111/1756-185X.13224.
Porritt RA, Paschold L, Rivas MN, et al. HLA class I–associated expansion of TRBV11-2 T cells in multisystem inflammatory syndrome in children. J Clin Invest. 2021;131(10):1-13. doi: https://doi.org/10.1172/JCI146614.
Noval Rivas M, Porritt RA, Cheng MH, Bahar I, Arditi M. COVID-19–associated multisystem inflammatory syndrome in children (MIS-C): A novel disease that mimics toxic shock syndrome—the superantigen hypothesis. J Allergy Clin Immunol. 2021;147(1):57-59. doi: https://doi.org/10.1016/j.jaci.2020.10.008.
Zhao Y, Patel J, Huang Y, Yin L, Tang L. Cardiac markers of multisystem inflammatory syndrome in children (MIS-C) in COVID-19 patients: A meta-analysis. Am J Emerg Med. 2021;49(May):62-70. doi: https://doi.org/10.1016/j.ajem.2021.05.044.
Mannarino S, Raso I, Garbin M, et al. Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study. Ital J Pediatr. 2022;48(1):1-9. doi: https://doi.org/10.1186/s13052-021-01189-z.
Tang X, Shao L, Dou J, et al. Fibrinogen as a Prognostic Predictor in Pediatric Patients with Sepsis: A Database Study. Mediators Inflamm. 2020;2020. doi: https://doi.org/10.1155/2020/9153620.
Chua GT, Wong JS, Chung J, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2: a case report. Hong Kong Med J. Published online 2022:7-9. doi: https://doi.org/10.12809/hkmj219689.
Jensen IJ, McGonagill PW, Berton RR, et al. Prolonged Reactive Oxygen Species Production following Septic Insult. ImmunoHorizons. 2021;5(6):477-488. doi: https://doi.org/10.4049/immunohorizons.2100027.
Rose-John S. Interleukin-6 Family Cytokines. Cold Spring Harb Perspect Biol. 2018;10(2):a028415. doi: https://doi.org/10.1101/cshperspect.a028415.
DeBiasi RL, Harahsheh AS, Srinivasalu H, et al. Multisystem Inflammatory Syndrome of Children: Subphenotypes, Risk Factors, Biomarkers, Cytokine Profiles, and Viral Sequencing. J Pediatr. 2021;237:125-135.e18. doi: https://doi.org/10.1016/j.jpeds.2021.06.002.
Diaz F, Bustos B R, Yagnam F, et al. Comparison of Interleukin-6 Plasma Concentration in Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Pediatric Sepsis. Front Pediatr. 2021;9(November):1-6. doi: https://doi.org/10.3389/fped.2021.756083.
Rosas IO, Bräu N, Waters M, et al. Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia. N Engl J Med. 2021;384(16):1503-1516. doi: https://doi.org/10.1056/nejmoa2028700.
Byler S, Baker A, Freiman E, Herigon JC, Eisenberg MA. Utility of specific laboratory biomarkers to predict severe sepsis in pediatric patients with SIRS. Am J Emerg Med. 2021;50:778-783. doi: https://doi.org/10.1016/j.ajem.2021.09.081.
Lautz AJ, Dziorny AC, Denson AR, et al. Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit. J Pediatr. 2016;179:74-81.e2. doi: https://doi.org/10.1016/j.jpeds.2016.07.045.
Nandy A, Mondal T, Datta D, et al. Serum Ferritin as a Diagnostic Biomarker for Severity of Childhood Sepsis. Indian Pediatr. 2021;58(12):1143-1146. doi: https://doi.org/10.1007/s13312-021-2396-y.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Inês Tovim, Francisco Abecasis
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and Authors' Rights
All articles published in Nascer e Crescer - Birth and Growth Medical Journal are Open Access and comply with the requirements of funding agencies or academic institutions. For use by third parties, Nascer e Crescer - Birth and Growth Medical Journal adheres to the terms of the Creative Commons License "Attribution - Non-Commercial Use (CC-BY-NC)".
It is the author's responsibility to obtain permission to reproduce figures, tables, etc. from other publications.
Authors must submit a Conflict of Interest statement and an Authorship Form with the submission of the article. An e-mail will be sent to the corresponding author confirming receipt of the manuscript.
Authors are permitted to make their articles available in repositories at their home institutions, provided that they always indicate where the articles were published and adhere to the terms of the Creative Commons license.
