Evaluation of cardiac abnormalities in multi-system inflammatory syndrome in children related multi-organ dysfunction syndrome

INTRODUCTION: Multi-system inflammatory syndrome in children hyperinflammation can cause multiple organ system dysfunction syndrome through mechanisms, including endothelial dysfunction and thrombotic microangiopathy. We evaluated potential endothelial damage and thrombotic microangiopathy as an underlying multi-system inflammatory syndrome in children associated multi-organ dysfunction syndrome pathophysiology. Cardiac dysfunction was assessed using echocardiogram and copeptin. METHODS: In pediatric ICU multi-system inflammatory syndrome in children patients, multi-organ dysfunction syndrome and thrombotic microangiopathy criteria were established using medical record data. Terminal complement and copeptin levels were evaluated alongside imaging (including echocardiogram), blood work, signs and symptoms of multi-organ dysfunction syndrome, and interventions documented during hospitalisation. Copeptin level correlation with multi-organ dysfunction syndrome severity and biomarkers of cardiac dysfunction were analysed. RESULTS: Of 12 pediatric ICU patients with multi-system inflammatory syndrome in children, 7 (58.33%) patients met multi-organ dysfunction syndrome criteria, and 8 (66.67%) met thrombotic microangiopathy criteria. Renal (66.67%) and cardiovascular (58.33%) dysfunction were most associated with multi-organ dysfunction syndrome. Multi-system inflammatory syndrome in children patients had higher terminal complement and copeptin levels compared to eight control subjects. Copeptin had a significant negative relationship with left ventricular ejection fraction and positive relationships with B-type natriuretic peptide and blood urea nitrogen but no other markers of renal or cardiac dysfunction. There was a strong positive relationship between copeptin and terminal complement. CONCLUSION: Multi-system inflammatory syndrome in children requiring pediatric ICU admission are multi-organ dysfunction syndrome-susceptible due to underlying complement-associated thrombotic microangiopathy. Copeptin can be used as a marker of acute critical illness and systolic dysfunction in multi-system inflammatory syndrome in pediatric patients. These biomarkers would guide clinicians earlier in the diagnosis and treatment of thrombotic microangiopathy-related multi-organ dysfunction syndrome due to multi-system inflammatory syndrome in children. However, their utility as markers for myocardial injury, diastolic dysfunction, and the severity of multi-organ dysfunction syndrome needs further evaluation.