{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:36:37Z","timestamp":1786988197913,"version":"build-2736575974"},"reference-count":93,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multisystem inflammatory syndrome in children (MIS\u2010C) is a severe hyperinflammatory condition associated with SARS\u2010CoV\u20102 infection and is frequently complicated by cardiovascular dysfunction, particularly shock. Early recognition of shock in MIS\u2010C is critical to reduce morbidity and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review and meta\u2010analysis aimed to evaluate the prevalence, comparative risk, and predictors of shock among children with MIS\u2010C, enhancing clinical management and informing future research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of PubMed, Embase and Web of Science was conducted from database inception to 15 July 2025. Observational studies reporting prevalence, comparative risk or predictors of shock in children with MIS\u2010C were included. Random\u2010effects meta\u2010analysis with Freeman\u2013Tukey double arcsine transformation was used to estimate pooled prevalence with 95% confidence intervals (CI). Relative risks (RR) were pooled for comparative analyses. Subgroup analyses, sensitivity analyses and meta\u2010regression were performed to explore heterogeneity. Publication bias was assessed using funnel plots and Egger's regression test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy studies involving 13\u2009263 children with MIS\u2010C were included. The pooled prevalence of shock was 56% (95% CI: 49%\u201363%), although substantial heterogeneity was observed (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200998.4%). Sensitivity analyses excluding studies with sample sizes &lt;\u200950 and &lt;\u2009100 participants yielded pooled prevalence estimates of 50% (95% CI: 40%\u201359%) and 46% (95% CI: 33%\u201359%), respectively. Subgroup analyses demonstrated variation according to publication year and diagnostic criteria. Children with MIS\u2010C had a significantly increased risk of shock compared with Kawasaki disease cohorts (RR\u2009=\u20098.52, 95% CI: 1.24\u201358.41;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05) and acute\/severe COVID\u201019 cohorts without MIS\u2010C (RR\u2009=\u20094.42, 95% CI: 2.44\u20138.02;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Echocardiographic abnormalities, myocardial dysfunction, elevated inflammatory markers and acute kidney injury were consistently associated with shock.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The certainty of evidence ranged from very low to low because of substantial heterogeneity, imprecision and methodological variability across studies. Despite these limitations, shock remains a frequent and serious complication of MIS\u2010C, highlighting the importance of early cardiovascular assessment and timely recognition of high\u2010risk children.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jpc.70470","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:29:55Z","timestamp":1781155795000},"page":"1346-1362","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence, Comparative Risk, and Predictors of Shock in Children With Multisystem Inflammatory Syndrome Associated With\n                    <scp>COVID<\/scp>\n                    \u201019: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3880-5579","authenticated-orcid":false,"given":"Asif","family":"Jan","sequence":"first","affiliation":[{"name":"Department of Pharmacy University of Peshawar  Peshawar KP Pakistan"},{"name":"Saidu Group of Teaching Hospitals  Saidu Sharif Swat KP Pakistan"},{"name":"District Headquarter Hospital Charsadda  Charsadda KP Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bushra","family":"Waheed","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Swabi  Swabi KP Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghadah Ali","family":"Hussein","sequence":"additional","affiliation":[{"name":"College of Medical and Health Technologies, Al\u2010Zahraa University for Women  Karbala Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2761-4151","authenticated-orcid":false,"given":"Pratima","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice National Institute of Pharmaceutical Education and Research  S.A.S. Nagar India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6214-4408","authenticated-orcid":false,"given":"Huma","family":"Sultana","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Chemistry Faculty of Pharmacy, MS Ramaiah University of Applied Sciences  Bangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubham","family":"Kumar","sequence":"additional","affiliation":[{"name":"Dental Research Cell, Dr. D. Y. Patil Dental College &amp; Hospital, Dr. D. Y. Patil Vidyapeeth (Deemed To Be University)  Pune India"},{"name":"Global Research Cell, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. 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