Distinguishing Between Multisystem Inflammatory Syndrome, Associated With COVID-19 in Children and the Kawasaki Disease: Development of Preliminary Criteria Based on the Data of the Retrospective Multicenter Cohort Study.

Mikhail M Kostik,Yuri A Kozlov,Tatiana L Kornishina,Liudmila V Bregel,Olesya S Efremova,Vera V Masalova,Elena A Dondurei,Olga V Kalashnikova,Ludmila S Snegireva,Vladimir V Shprakh,Alla E Matyunova,Vyacheslav G Chasnyk,Ilia S Avrusin,Eugenia A Isupova

doi:10.3389/fped.2021.787353

Mikhail M Kostik, Yuri A Kozlov + Show 12 more

Open Access

https://doi.org/10.3389/fped.2021.787353

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Abstract

Objectives: Diagnostic between multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) and Kawasaki disease (KD) can make difficulties due to many similarities. Our study aimed to create a Kawasaki/MIS-C differentiation score (KMDscore) allowing discrimination of MIS-C and KD.Study design: The retrospective multicenter cohort study included clinical, laboratory, and instrumental information about MIS-C (n = 72) and KD (n = 147). The variables allowed to discriminate both conditions used to construct and validate the diagnostic score called the KMDscore.Results: Patients with MIS-C were older, had earlier admission to the hospital, had a shorter time before fever resolution, two times frequently had signs of GI and CNS involvement observed, and had more impressive thrombocytopenia, higher level of CRP, ferritin, ALT, AST, LDH, creatinine, triglycerides, troponin, and D-dimer compared to KD patients. Respiratory signs in MIS-C were presented with pleuritis, acute respiratory distress syndrome, oxygen dependency, lung infiltration, and ground-glass opacities in CT. The heart involvement with fast progression of myocarditis provided the severity of MIS-C and ICU admission due to 12 times higher arterial hypotension or shock and required cardiotonic. No differences in the frequency of CA lesions were seen in the majority of cases. Five criteria, CRP >11 mg/dl (18 points), D-dimer >607 ng/ml (27 points), age >5 years (30 points), thrombocytopenia (25 points), and GI involvement (28 points), were included in the KMDscore. The summa >55 points allowed to discriminate MIS-C from KD with a sensitivity of 87.5% and specificity of 89.1%.Conclusion: The KMDscore can be used to differentiate the diagnostic of MIS-C from KD.

Highlights

In December 2019, the first case of a new coronavirus infection with the severe acute respiratory syndrome (SARS-CoV-2) was registered in China for the first time
Diagnostic between multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) and Kawasaki disease (KD) can make difficulties due to many similarities
Patients with MIS-C were older, had earlier admission to the hospital, had a shorter time before fever resolution, two times frequently had signs of GI and CNS involvement observed, and had more impressive thrombocytopenia, higher level of CRP, ferritin, ALT, AST, LDH, creatinine, triglycerides, troponin, and D-dimer compared to KD patients

Summary

Introduction

In December 2019, the first case of a new coronavirus infection with the severe acute respiratory syndrome (SARS-CoV-2) was registered in China for the first time. The COronaVIrus Disease 2019 (COVID-19) pandemic has rapidly developed into a global health emergency around the world. This disease is observed relatively less often in children than in adults (1–5% of diagnosed diseases among the population at the beginning of the pandemic) [1]. Since April 2020, there have been many reports that a new coronavirus infection may be associated with a childhood hyperinflammatory condition that fully or partially meets the criteria of Kawasaki disease (KD) [5]

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