Clinical, laboratory and echocardiographic parameters suggestive of multi-system inflammatory syndrome in children at a tertiary hospital in South Africa

Background. Worldwide studies have described features and outcomes of multi‐system inflammatory syndrome in children (MIS‐C) to assist with the diagnosis and guide medical management, with few studies emanating from Africa. Objective. To describe the clinical, laboratory and echocardiographic parameters suggestive of MIS‐C. Methods. The paediatric cardiology database identified all patients referred with suspected MIS‐C at Chris Hani Baragwanath Academic Hospital (CHBAH), from 1 March 2020 until 31 December 2021. Patients were classified as ‘MIS‐C likely’ or ‘MIS‐C unlikely’ based on the 2020 Centers for Disease Control and Prevention (CDC) criteria for MIS‐C. Results. A total of 101 patients were analysed, with 60 in the ‘MIS‐C likely’ group and 41 patients in the ‘MIS‐C unlikely’ group. The significant clinical features differentiating between the ‘MIS‐C likely’ and the ‘MIS‐C unlikely’ groups were the presence of documented fever (p=0.018) and eye changes (p<0.001). Patients with a positive COVID antibody test that were referred for suspected MIS‐C were most likely to present with MIS‐C (p< 0.001). Laboratory parameters suggesting a greater likelihood of patients having MIS‐C was a high troponin T (p=0.018) and a high C‐reactive protein (CRP) (p=0.019). The main echocardiographic feature associated with a MIS‐C diagnosis was left ventricular (LV) dysfunction at presentation (p=0.023). In the adjusted logistic regression analyses, the contributory findings associated with a greater risk of having MIS‐C were fever and LV dysfunction (OR 6.52 (95% CI 2.31 ‐ 18.45); p<0.001 and 6.70 (95% confidence interval (CI) 1.61 ‐ 28.59); p =0.009, respectively). Conclusion. Clinical features such as documented fever and eye changes together with a positive COVID antibody test suggest that patients had MIS‐C in our setting. Laboratory findings of elevated CRP and troponin T in patients with suspected MIS‐C assisted with the diagnosis. Patients with suspected MIS‐C with LV dysfunction at presentation were more likely to have MIS‐C.