Identifying MIS-C with Risk Prediction Model
Monday, February 07, 2022
by Physicians Office Resource
While children often recover quickly from COVID-19, with the emergence of the highly contagious omicron variant, cases and hospitalizations are on the rise. With the rise in COVID-19 cases, brings on another concern, MIS-C.
What is MIS-C?
According to the CDC, “Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.” Scientists aren’t quite sure what causes MIS-C; however they do know that many children with MIS-C have had COVID-19. The CDC continues, “MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care.”1
MIS-C often comes as a surprise to parents and clinicians as some who develop this serious condition never showed signs or symptoms of COVID-19 and symptoms of MIS-C often do not arise until two to six weeks after COVID-19 infection.
While MIS-C is rare, there have been almost 6,500 cases and 55 deaths over the last year. Experts expect that number to increase this year as we battle against the highly contagious omicron variant, especially within children younger than 5 who are unable to receive the vaccine.
Can MIS-C be Prevented?
Much is still being learned about MIS-C and its relationship to COVID-19, however according to a new report from the CDC, the “estimated effectiveness of 2 doses of Pfizer-BioNTech vaccine against MIS-C was 91% [in patients aged 12-18]. Among critically ill MIS-C case patients requiring life support, all were unvaccinated.”2
MIS-C Prediction Model
Late last year, a team of medical scientists and investigators from Vanderbilt University and John Hopkins presented a risk prediction model at the annual meeting of the American College of Rheumatology. The model utilizes clinical, laboratory, and cardiac feature to help identify MIS-C cases within 24 hours of observed symptoms. Identifying MIS-C is difficult because MIS-C shares features common with infectious and inflammatory syndromes. Therefore, having a prediction model could be verry valuable to clinicians needing to identify these cases quickly and accurately.4
The four predictors in the model included:
- Hypotension (defined as requiring fluid resuscitation, vasopressor support or blood pressure less than 10th percentile for age, height, and sex).
- Abdominal Pain
- Serum Sodium
To develop this prediction model, investigators used retrospective chart data of children less than 20 years old that were evaluated for MIS-C at Vanderbilt Children's Hospital during the pandemic. While in the care of the hospital, clinicians collected a set of standardized clinical, lab, and cardiac characteristics. In all the trial population included 127 children admitted to the Vanderbilt hospital that were evaluated for MIS-C. Utilizing the retrospective chart data of the 127 children evaluated for MIS-C, 45 cases of MIS-C were confirmed versus 82 non-cases.
Matthew Clark, MD, RhMSUS and lead investigator on the study said, “We used early clinical and laboratory features to inform the design of a clinical diagnostic prediction model with excellent discrimination to assist clinicians in distinguishing patients with MIS-C from those without…We plan to test this model with external and prospective validation.”3