184 - OUTCOMES AND MIDTERM MONITORING OF MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN

Backround: Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by cardiac involvement causing shock and coronary artery abnormalities, along with clinical features reminiscent of Kawasaki Disease (KD). Our study focuses on the clinical characteristics of a prospectively followed cohort from diagnosis to post discharge follow-up.

Methods: A total of 90 patients with MIS-C presented for admission between September 2020 and July 2022 at single center in Turkey. Patients were stratified according to severity of illness and different immunomodulatory treatments were given including, IVIG and Corticosteroid (CS), IVIG plus CS plus anakinra, and IVIG plus CS plus anakinra plus plasmapheresis. Patient data were collected from admission until 6 months after discharge.

Results: Of the 90 cases 36 (40%) presented with shock, 32 (36%) with KD-like features, and 21 (23%) with fever and inflammation. Seventy-one (79%) of the patients exhibited cardiac abnormality, as evidenced by findings in electrocardiography, echocardiography, or elevated BNP or Troponin levels. Ferritin, CRP, and procalcitonin levels were significantly elevated in the shock patients. Three-quarters of the shock patients developed valve insufficiency, and pericardial effusion was seen in 41%. Among the shock group, 95% received anakinra, and 65% underwent additional plasma exchanges. Totally, twenty-three (26%) patients required respiratory support, and inotropic agents were administered to 36 (40%) cases. One patient required extracorporeal membrane oxygenation (ECMO), and there were no deaths. The median length of hospitalization was 6 days.

Patients were evaluated during the initial, second, and third follow-up visits, with percentages of 97%, 79%, and 49%, respectively, occurring on median days 10, 91, and 179 following discharges. While CRP, ferritin, procalcitonin, and albumin normalized completely in the first follow-up, ESR and triglycerides normalized in the second follow-up. Since admission and throughout follow-ups 7 (8%) patients developed coronary artery abnormalities (CAAs) (Z-score > 2.0), of which 6 patients’ CAAs resolved by last follow-up (Table 1 and Figure 1).

Conclusion: There was a wide range of clinical manifestations of MIS-C following SARS-CoV-2 infection and shock was characterized by more severe hyperinflammation compared others. The mid-term longitudinal assessment of these patients showed that timely immunomodulatory therapies provide a safe resolution over this wide range of clinical courses particularly cardiac involvement.