Fatores que diferenciam a Síndrome Inflamatória Multissistêmica Pediátrica de outras doenças febris agudas na admissão em Unidade de Emergência - Experiência de um serviço terciário

Abstract

OBJECTIVE: To establish clinical and laboratory parameters that allow the differentiation, on hospital admission, between patients with the multisystem inflammatory syndrome in children defined by CDC/WHO classification criteria - MIS-C (Group 1) and patients with other febrile syndromes unrelated to SARS-CoV-2 infection (Group 2). METODOLOGY: Retrospective, cross-sectional observational study of patients under 18 with febrile syndromes evaluated from March 2020 to October 2021. The groups were compared using Fisher exact and Wilcoxon tests, level of significance of 5%. The relative risk (RR) and adjusted, 95% CI, were used as measures of association, and a conditional inference tree was used to identify the cutoffs of continuous variables. RESULTS: Of the 44 patients who met MIS-C criteria, only 23 had confirmed SARS-CoV-2 infection by positive RT-PCR or antibody test (group 1), despite positive epidemiology in both groups: Group 1 (44.8%) and Group 2 (14.3%). Twelve febrile syndromes, particularly viral gastroenteritis, mimicked MIS-C. The skin rash, RR 5.0 (95% CI, 1.7 -14.5), CRP > 6.4 mg/dl, RR 3.7 (95% CI, 1.3 - 10.0), age > 31 months, RR 2.7 (95% CI, 1.2 - 6.0), hyponatremia, RR 2.1 (95% CI, 1.3 - 3.5), and previous antibiotic RR 1.9 (95% CI, 1.1 - 3.1), were associated with a confirmatory diagnosis of MIS-C. Patients with CRP levels higher than 6.4 mg/dl were three times more likely to have a confirmatory diagnosis of MIS-C. CONCLUSION: CRP levels higher than 6.4 mg/dl and skin rash present on admission was the leading risk factor associated with MIS-C.