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We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (<jats:italic>p<\/jats:italic>\u2009=\u20090.002): 9.4\u00a0years (IQR 5.5\u201311.8) vs 3.4\u00a0years (IQR 0.4\u20139.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, <jats:italic>p<\/jats:italic>\u2009=\u20090.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), diarrhea (66.7% vs 11.5%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), vomits (71.1% vs 23.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), fatigue (65.9% vs 36%, <jats:italic>p<\/jats:italic>\u2009=\u20090.016), shock (84.4% vs 13.8%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and cardiac dysfunction (53.3% vs 10.3%, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). MIS-C group had a lower lymphocyte count (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and LDH (<jats:italic>p<\/jats:italic>\u2009=\u20090.001) but higher neutrophil count (<jats:italic>p<\/jats:italic>\u2009=\u20090.045), neutrophil\/lymphocyte ratio (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), C-reactive protein (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and procalcitonin (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), corticosteroids (80% vs 44.8%, <jats:italic>p<\/jats:italic>\u2009=\u20090.003) and immunoglobulins (51.1% vs 6.9%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5\u00a0days (IQR 2.5\u20138\u00a0days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.\n<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13054-020-03332-4","type":"journal-article","created":{"date-parts":[[2020,11,26]],"date-time":"2020-11-26T11:04:57Z","timestamp":1606388697000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":126,"title":["Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain"],"prefix":"10.1186","volume":"24","author":[{"name":"the Spanish Pediatric Intensive Care Society working group on SARS-CoV-2 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