Abstract
BACKGROUND:Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a rare but severe disease in which various organs and systems are affected, including heart, lungs, kidneys, brain, skin, eyes and organs of the gastrointestinal tract. MIS-C is rather difficult to diagnose, since it has much in common with the infectious process, and Kawasaki disease. However, MIS-C course is more severe and therefore patients need hospitalization in the intensive care unit in half of the cases.
 AIM:To determine the factors associated with severe course of MIS-C, requiring hospitalization of patients in the intensive care unit.
 MATERIALS AND METHODS:The retrospective study included 166 patients (99 boys, 67 girls), aged 4 months to 17 years (median 8.2 years), with a diagnosis of multisystem inflammatory syndrome associated with COVID-19 in children. To conduct a comparative analysis, patients with MIS-C were divided into two groups: group 1 patients hospitalized in the intensive care unit (n= 84, 50.6%), and group 2 patients who did not need hospitalization in the intensive care unit (n= 82, 49.4%).
 RESULTS:Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin and D-dimer levels. Also, in patients hospitalized in the intensive care unit, signs of hemophagocytic syndrome were more often observed.
 CONCLUSIONS:The main factors determining the severity of MIS-C are damage to the cardiovascular system, the central nervous system, the presence of respiratory and hemodynamic disorders, especially hemophagocytosis.
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