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Abstract

Objectives: Multisystem Inflammatory Syndrome in children (MIS-C) is a post SARS-CoV-2 immune dissonance seen in the pediatric population. The current study is an attempt to understand subtleties of diverse phenotypes, immunotherapeutics and short-term outcome parameters of MIS-C. Methodology: Children admitted to Pediatric intensive care unit [PICU] between 1 month – 18 years, satisfying MIS-C criteria were enrolled in this retrospective observational study. They were stratified into different phenotypes like shock, Kawasaki disease and non - specific phenotypes. Respiratory, vasoactive support and outcomes were analyzed using appropriate statistical methods. Results: Seventy-five children presented with MISC during the study period. The mean age was 66 months with 54.6% females. COVID antibody was positive for 41 [54%], RTPCR positivity noted in 16 [21.3%] and RAT was positive in 10 [13%]. Common symptoms included fever (100%), rash (30%), conjunctival congestion (29.7%), cardiovascular (68% with shock) involvement. Notable differences in shock phenotype were identified including PRISM III score, inflammatory markers, cardiac involvement, need of inotropes and ventilation. Thirty-two per cent received intravenous immunoglobulin and 48% glucocorticoids. The overall mortality in children with MIS-C was 9 (12%). The need for mechanical ventilation [OR10.94, CI (2.06,58.06), p value <0.005] was noted as an independent predictor of mortality by logistic regression. Conclusion: MIS-C has a significant cardiovascular involvement at presentation, necessitating intensive care and immunomodulatory therapies. There were higher odds of mortality in the ventilated cohort.

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