{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T16:19:57Z","timestamp":1781194797970,"version":"3.54.1"},"reference-count":33,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T00:00:00Z","timestamp":1650931200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>Objective: We describe the trajectory of clinical course, laboratory markers and outcomes in children with severe multi\u2014inflammatory syndrome temporally related to COVID-19 (MIS-C) admitted to our pediatric intensive care unit (PICU) . Methods: This was a prospective case series of children admitted to PICU between May 1, 2020 and January 31, 2021, fulfilling the case definition of MIS-C published by World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC). We analyzed demographic, clinical, laboratory data and echocardiographic findings. We also plotted the variation in trends between survivors and nonsurvivors. Results: Of the 34 critically ill children referred to PICU with diagnosis of MIS-C only 17 fulfilled the WHO\/CDC classification of MIS-C, rest were MISC mimickers albeit other tropical infections. Median age at admission was 4 years (range 1y 6 mo-8 years). Fever, rash and conjunctival redness were most prominent symptoms. Myocardial involvement was seen in 70.5% while 76.4% developed shock; Invasive mechanical ventilation was required in 64.7% cases. Inflammatory markers showed a downward trend such as\u2014median C- reactive protein (mg\/L) had a serial reduction in levels\u2014from (median\/IQR) 210 (132.60, 246.90) at admission to 52.3 (42, 120) on Day 3. Median Ferritin (ng\/ml) (n\u2009=\u200912) was 690 (203, 1324), serum LDH (IU\/L) (n\u2009=\u200912) was 505 (229.5, 1032) and Mean D-dimer (ng\/ml) (n\u2009=\u20097) was 5093.85 (1991.65), suggestive of hyperinflammatory syndrome. Twelve patients received intravenous immune globulin, with adjunctive steroid therapy used in two third of the cases. Six children died, 4 of them were under\u20145 years of age. Tocilizumab was prescribed in two children with high vasotrope inotrope score (VIS), cardiogenic shock and oxygenation index more than 15, both survived. Conclusions: Severe MIS-C has a heterogenous presentation, local or regional outbreaks of prevalent infectious diseases often lead to confusion and overdiagnosis. Higher proportion of mortality was seen in Under \u22125 children with MISC. Shock\u2014like presentation, presence of myocardial dysfunction or nonsurvivor status is associated with higher trend of inflammatory markers and more profound multi-organ dysfunction. If disease progresses rapidly despite first line therapy (IvIg and steroids), use of Tocilizumab should be considered\u2014as a rescue therapy under resource limitations in the absence of extracorporeal support.<\/jats:p>","DOI":"10.1177\/08850666221092302","type":"journal-article","created":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T03:03:53Z","timestamp":1650942233000},"page":"1229-1237","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Severe Multi-inflammatory Syndrome in Children Temporally Related to COVID 19\u2014Clinical Course, Laboratory Profile and Outcomes from a North Indian PICU"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1692-9474","authenticated-orcid":false,"given":"Arpita","family":"Chattopadhyay","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karnika","family":"Saigal Kalra","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diganta","family":"Saikia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varshanjali","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juhi","family":"Chouksey","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamta","family":"Jajoo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. L.","family":"Sherwal","sequence":"additional","affiliation":[{"name":"Director, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,4,26]]},"reference":[{"key":"bibr1-08850666221092302","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31094-1"},{"key":"bibr2-08850666221092302","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.10369"},{"key":"bibr3-08850666221092302","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-020-02391-2"},{"key":"bibr4-08850666221092302","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31103-X"},{"key":"bibr5-08850666221092302","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2021680"},{"key":"bibr6-08850666221092302","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2021756"},{"key":"bibr7-08850666221092302","volume-title":"Pediatric Inflammatory Multisystem Syndrome and SARS-CoV-2 Infection in Children\u201415 May 2020","author":"European Centre for Disease Prevention and Control","year":"2020"},{"issue":"681","key":"bibr8-08850666221092302","first-page":"683","volume":"57","author":"Balasubramanian S","year":"2020","journal-title":"Indian Pediatr"},{"key":"bibr9-08850666221092302","unstructured":"Royal College of Pediatrics and Child Health. Guidance\u2014Pediatric multisystem inflammatory syndrome temporally associated with COVID-19, 2020. https:\/\/www.rcpch.ac.uk\/resources\/guidance-pediatric-multisystem-inflammatory-syndrometemporally-associated-covid-19. Accessed March 24, 2020."},{"key":"bibr10-08850666221092302","unstructured":"Multisystem inflammatory syndrome in children and adolescents with COVID-19. 15 May 2020 Scientific brief: World Health Organisation. https:\/\/www.who.int\/publications-detail\/multisystem-inflammatory-syndrome-in-children-and adolescents-with-covid-19. Accessed March 22, 2021."},{"key":"bibr11-08850666221092302","unstructured":"Centers for Disease Control and Prevention. Emergency preparedness and response: Health alert network. [May 14, 2020]. https:\/\/emergency.cdc.gov\/han\/2020\/han00432.asp. 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