64 - VALUE OF A THREE-POINT SCORE FOR CARDIOGENIC SHOCK PREDICTION IN MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN

BACKGROUND/

Aim: In multisystem inflammatory syndrome in children (MIS-C or PIMS temporally associated with SARS-CoV-2), cardiogenic shock is a serious frequent complication. A three-point score, including the patient’s age > 8 years, the N-terminal pro-B-type natriuretic peptide (NT-proBNP) at diagnosis > 11,000 pg/mL, and the time to diagnosis (time from the first symptom to diagnosis) ≥ 6 days, has been suggested for its prediction. The aim of the present study was to validate this score in a different cohort.

Methods: A multicentre cohort prospectively included patients diagnosed with MIS-C, according to the World Health Organization definition, from April 2020 to October 2020. B-type natriuretic peptide (BNP) and NT-proBNP values were collected at diagnosis. BNP values were converted to NT-proBNP using a published formula. Time to diagnosis was assessed by 2 independent physicians. Receiver operating characteristic curve analysis was used.

Results: Fifty-nine children (29 females (49%), median age (interquartile range) 8.7 (5.0 – 11.2) years, 41 (69%) with cardiogenic shock) with available data were included. Median NT-proBNP at diagnosis was 9,810 (3,025 – 21,457) pg/mL and median time to diagnosis was 5.4 (4.0 – 6.0) days. The area under the curve was 0.800. A score of 3 had a sensitivity, specificity, positive and negative predictive values of 32% (95% confidence interval 18-48%), 100% (81-100%), 100% (75-100%), and 39% (26-55%) respectively, whereas these were 61% (45-76%), 89% (65-98%), 93% (76-99%), and 50% (32-68%) respectively for a score of at least 2.

Conclusion: The three-point score showed an excellent specificity but a poor sensitivity for cardiogenic shock prediction. Modifications of the score are necessary to improve sensitivity and negative predictive value.