POS1262 A COHORT STUDY OF COVID-19 RELATED MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN AND ADOLESCENTS FROM MULTIPLE TERTIARY CARE CENTRES IN SOUTH INDIA
Authors: A. Tiwari, A. Rauf, S. Kesavan, M. Kappanayil, S. Sivadas, S. Balan, P. Chickermane
Journal: Annals of the Rheumatic Diseases (2021)

Background: After the peak of COVID 19 pandemic, a surge of cases with multi-system involvement and hyperinflammatory state was reported in children, at multiple tertiary care centers across the world. (1) This COVID-19 associated multisystem inflammatory syndrome in children and adolescents is also known as multisystem inflammatory syndrome in children (MIS-C). There is a paucity of literature of clinical profile of MIS-C patients from India. Objectives: To study the clinical manifestations and treatment outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C) and adolescents. Methods: It was a cohort study including cases defnied as per the case definitions of MIS-C by World Health Organisation (WHO) or Centre for Disease Control and Prevention(CDC). (2) The clinical parameters, laboratory parameters (including inflammatory markers, D dimer and NT ProBNP), electrocardiogram, 2D echocardiogram, course in hospital, and immediate outcomes were noted. Results: Twenty five patients (male-14) with a mean age of 6.22 ±4.25 years and a mean body mass index of 16.21 ±3.36 kg/m 2 were enrolled on the study. Average length of hospital stay was 8.12±5.76 days. Associated comorbidities were present in 4 of our patients (16%). Figure 1 shows the frequency of clinical features in our study patients. Table 1 shows the clinical, laboratory, imaging findings, disease course and outcomes. Figure 1. Frequency of clinical features in our MIS-C cohort patients Table 1. Clinical characteristics of MIS-C patients (n)=25 Clinical Phenotypes: Incomplete/ Atypical Kawasaki Disease (KD) 18 (72%) Macrophage activation syndrome (MAS) 11 (44%) Unexplained Shock 13 (52%) Fever with gastrointestinal symptoms 17 (68%) Fever with neurological symptoms 9 (36%) Fever with respiratory symptoms 5 (20%) COVID chronology: MISC with acute COVID 19 with MAS 1 (4%) MISC with acute COVID 19 with incomplete/atypical KD 1 (4%) COVID 19 tests: COVID 19 RTPCR positive 2 (8%) COVID 19 RTPCR negative 23 (92%) COVID 19 IgG positive 20 (80%) COVID 19 IgM positive 6 (24%) COVID 19 IgG and IgM both positive 2 (8%) COVID 19 IgG and IgM not done 4 (16%) Other laboratory investigations (Peak/ trough values): Anaemia 20 (80%) Leukopenia 2 (8%) Thrombocytopenia 6 (24%) Pancytopenia 2 (8%) Positive CRP 23 (92%) High Procalcitonin 9 (36%) High ferritin 10 (40%) High D- dimer 17 (68%) High NT ProBNP 23 (92%) Hypoalbuminemia 14 (56%) Sterile pyuria 7 (28%) Proteinuria 4 (16%) Cardiac assessment: Abnormal Electrocardiogram (ECG) 5 (20%) Abnormal Echocardiography 15 (60%) Coronary dilation/prominence/non-tapering 9 (36%) Coronary aneurysm 1 (4%) LAD Z score (Mean±SD) 2.12 ± 1.11 Decreased Ejection fraction (EF) 5 (20%) Systolic Dysfunction 5 (20%) Pericardial effusion 9 (36%) Global/septal hypokinesia 4 (16%) Mitral Valve regurgitation 3 (12%) Complete heart block 1 (4%) Twenty patients (80%) had severe illness requiring intensive care. Fourteen patients (56%) required inotropic support, 8 patients (32%) required supplemental oxygen, 5 patients (20%) required mechanical ventilation and 2 patients (8%) expired. A total of 23 patients (92%) received pulse steroids followed by oral/iv steroids, 22 patients (88%) received IVIG (2g/kg) and 3 patients (12%) required anticoagulation. Conclusion: Our MIS-C cohort had varied clinical manifestations ranging from the mild cutaneous and gastrointestinal symptoms to fatal multiorgan dysfunctions. In contrast to western cohorts, our study cohort had higher number of patients from younger age group and lower BMI. References: [1]Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020;26:100527. [2]Jiang L, Tang K, Levin M, Irfan O, Morris S, Wilson K et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. The Lancet Infectious Diseases. 2020;20(11):e276-e288. Disclosure of Interests: None declared