Multisystem inflammatory syndrome in children (MIS-C) and sepsis differentiation by a clinical and analytical score: MISSEP score
Por:
Hernández-García M, Roldan-Berengue E, Guitart-Pardellans C, Girona M, Argüello G, Pino R, Fernández de Sevilla-Estrach M, García-García JJ and Jordán-García I
Publicada:
1 nov 2023
Ahead of Print:
1 sep 2023
Categoría:
Pediatrics, perinatology and child health
Resumen:
Differential diagnosis between Multisystem Inflammatory Syndrome in Children (MIS-C) and other causes of systemic inflammatory response such as sepsis is complex. The aims were to evaluate the differences between pediatric patients with MIS-C and sepsis and to develop a score to distinguish both entities. This was a retrospective study that compared demographic, clinical, diagnostic, and therapeutic data of pediatric patients with MIS-C (cohort 2020-2022) and sepsis (cohorts 2010-2014 and 2017-2018) admitted to a Pediatric Intensive Care Unit (PICU) of a tertiary care hospital. A diagnostic score was developed with variables that differentiated the two conditions. Twenty-nine patients with MIS-C were identified, who were matched 1:3 with patients with sepsis (n = 87). Patients with MIS-C were older (10 vs. 4 years old), and the majority were male (69%). Clinical characteristics that demonstrated differences were prolonged fever and signs and symptoms affecting skin-mucosa and gastrointestinal system. Leukocytes, PCT, and ferritin were higher in sepsis, while thrombocytopenia, lymphopenia, and elevated fibrinogen and adrenomedullin (biomarker with a role for the detection of invasive infections) were more frequent in MIS-C. MIS-C patients presented greater myocardial dysfunction (p < 0.001). Five criteria were selected and included in the MISSEP score after fitting them into a multivariate logistic regression model: fever > 48 hours (20 points), thrombocytopenia < 150 x 10(3)/mu L (6 points), abdominal pain (15 points), conjunctival erythema (11 points), and Vasoactive Inotropic Score (VIS) > 10 (7 points). The cutoff > 25 points allowed to discriminate MIS-C from sepsis with a sensitivity of 0.89 and specificity of 0.95. Conclusion: MIS-C phenotype overlaps with sepsis. MISSEP score could be useful to distinguish between both entities and direct specific treatment.
Filiaciones:
:
Paediatrics Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
Roldan-Berengue E:
Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
Guitart-Pardellans C:
Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
Paediatric Intensive Care Unit, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
Girona M:
Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
Paediatric Intensive Care Unit, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
Argüello G:
Faculty of Computer Science, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
Statistics and Operations Research, Universidad de Oviedo, Oviedo, Asturias, Spain
Pino R:
Paediatrics Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
Fernández de Sevilla-Estrach M:
Paediatrics Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain
García-García JJ:
Paediatrics Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain
Jordán-García I:
Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain.
Paediatric Intensive Care Unit, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain.
Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain.
Green Submitted, hybrid
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