MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN ASSOCIATED WITH COVID-19: RESULTS OF A MULTICENTER STUDY
Authors:   People’s Friendship University of Russia, Moscow, Russia, Novikova Yu.Yu. ,   Morozov Children’s City Clinical Hospital, Moscow, Russia, Ovsyannikov D.Yu. ,   People’s Friendship University of Russia, Moscow, Russia,   Morozov Children’s City Clinical Hospital, Moscow, Russia,   Moscow City Children's Infectious Diseases Hospital No. 6 of the Moscow Department of Healthcare, Moscow, Russia, Glazyrina A.A. ,   People’s Friendship University of Russia, Moscow, Russia,   Morozov Children’s City Clinical Hospital, Moscow, Russia, Zvereva N.N. ,   Pirogov Russian National Research Medical University, Moscow, Russia, Peters S.S. ,   Sverdlovsk Oblast Regional Children’s Clinical Hospital, Yekaterinburg, Sverdlovsk Oblast, Russia, Abdullaev A.N. ,   Sverdlovsk Oblast Regional Children’s Clinical Hospital, Yekaterinburg, Sverdlovsk Oblast, Russia, Afukov I.I. ,   Pirogov Russian National Research Medical University, Moscow, Russia, Bogdan P.I. ,   Pirogov Russian National Research Medical University, Moscow, Russia, Vakhlova I.V. ,   Urals State Medical University, Yekaterinburg, Sverdlovsk Oblast, Russia, Gorev V.V. ,   Morozov Children’s City Clinical Hospital, Moscow, Russia, Degtyareva E.A. ,   People’s Friendship University of Russia, Moscow, Russia,   Moscow City Children's Infectious Diseases Hospital No. 6 of the Moscow Department of Healthcare, Moscow, Russia, Zhdanova O.I. ,   Moscow City Children's Infectious Diseases Hospital No. 6 of the Moscow Department of Healthcare, Moscow, Russia, Zorina M.A. ,   Pirogov Russian National Research Medical University, Moscow, Russia, Kantemirova M.G. ,   People’s Friendship University of Russia, Moscow, Russia,   Morozov Children’s City Clinical Hospital, Moscow, Russia,   Moscow City Children's Infectious Diseases Hospital No. 6 of the Moscow Department of Healthcare, Moscow, Russia, Karpenko M.A. ,   People’s Friendship University of Russia, Moscow, Russia,   Moscow City Children's Infectious Diseases Hospital No. 6 of the Moscow Department of Healthcare, Moscow, Russia, Kolganova N.I. ,   People’s Friendship University of Russia, Moscow, Russia, Kryshova E.S. ,   Morozov Children’s City Clinical Hospital, Moscow, Russia, Kurbanova S.Kh. ,   Morozov Children’s City Clinical Hospital, Moscow, Russia, Nikolishin A.N. ,   Morozov Children’s City Clinical Hospital, Moscow, Russia, Pastukhov P.A. ,   Sverdlovsk Oblast Regional Children’s Clinical Hospital, Yekaterinburg, Sverdlovsk Oblast, Russia, Petryaykina E.E. ,   People’s Friendship University of Russia, Moscow, Russia,   Morozov Children’s City Clinical Hospital, Moscow, Russia,   Pirogov Russian National Research Medical University, Moscow, Russia, Rtishchev A.Yu. ,   People’s Friendship University of Russia, Moscow, Russia,   Morozov Children’s City Clinical Hospital, Moscow, Russia,   Pirogov Russian National Research Medical University, Moscow, Russia, Saifullin M.A. ,   Pirogov Russian National Research Medical University, Moscow, Russia, Sergeev D.A. ,   Pirogov Russian National Research Medical University, Moscow, Russia, Sokotova T.V. ,   Sverdlovsk Oblast Regional Children’s Clinical Hospital, Yekaterinburg, Sverdlovsk Oblast, Russia, Kharkin A.V. ,   Pirogov Russian National Research Medical University, Moscow, Russia, Chagirev V.N. ,   Morozov Children’s City Clinical Hospital, Moscow, Russia, Shchederkina I.O. ,   Morozov Children’s City Clinical Hospital, Moscow, Russia
Published: November 2021

Coronavirus disease 2019 (COVID-19) in children in most cases is asymptomatic or mild, and its most severe late complication is multisystem inflammatory syndrome in children (MIS-C). The aim of the study is to find clinical, laboratory and instrumental characteristics, description of therapeutic tactics, including determination of the profile of patients requiring Tocilizumab prescription and the outcomes of MIS-C associated with COVID-19. Materials and methods of research: 245 children aged 3 months – 17 years old were included in the pilot prospective multicenter open-label comparative study with MIS-C associated with COVID-19, verified based on CDC criteria (2020). Results: the median age of patients was 8 [5; 10] years, boys predominated among the patients (57.1%); MIS-C manifested itself as a combination of the symptom complex of Kawasaki disease (KD, 53.1% of patients), more often of atypical form, cardiovascular (66.1%), gastrointestinal (61.2%), neurological (27.3%) symptoms and signs of detection of the urinary (29.4%) and respiratory (19.6%) systems; macrophage activation syndrome (MAS) was diagnosed in 19.5% of patients. Therapy included glucocorticosteroids (97.6%), antibiotics (95.5%), anticoagulants (93.9%), intravenous immunoglobulin (34.7%), vasoactive/vasopressor support (31.8%), Tocilizumab (15.1%), mechanical ventilation (2.4%), extracorporeal membrane oxygenation (0.4%). Patients receiving Tocilizumab, statistically significantly more often compared with patients without this therapy, were in the intensive care unit (ICU, 86.5% versus 40.9%, p<0.001), more often required vasopressor therapy (70.3% versus 25%, p<0.001), had statistically significantly higher markers of laboratory inflammatory activity. Treatment in 47.8% of cases was carried out in an ICU; one child has died. In 4.1%, according to echocardiography, coronaritis, ectasia of the coronary arteries without the formation of persistent aneurysms were detected. Conclusion: MIS-C associated with COVID-19 has clinical signs of KD, often of the incomplete form, accompanied by arterial hypotension/shock, MAS, which requires intensive therapy, and the prescription of Tocilizumab.