Qalab Abbas, Haider Ali, Fatima Amjad, Muhammad Zaid Hamid Hussain, Abdu R Rahman, Maryam Hameed Khan, Zahra A Padhani, Fatima Abbas, Danyal Imam, Zuviya Alikhan, Sameer M Belgaumi, Shazia Mohsin, Faiza Sattar, Arsalan Siddiqui, Zohra S Lassi, Jai K Das
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Mean and prevalence ratios for various variables were pooled by random effects model using R. A mixed generalised linear model was employed to account for the heterogeneity, and publication bias was assessed via funnel and Doi plots. The primary outcome was pooled mean mortality among patients with MIS-C. Subgroup analysis was conducted based on the income status of the country of study.</p><p><strong>Results: </strong>A total of 120 studies (20 881 cases) were included in the review. The most common clinical presentations were fever (99%; 95% CI 99.6% to 100%), gastrointestinal symptoms (76.7%; 95% CI 73.1% to 79.9%) and dermatological symptoms (63.3%; 95% CI 58.7% to 67.7%). Laboratory investigations suggested raised inflammatory, coagulation and cardiac markers. The most common management strategies were intravenous immunoglobulins (87.5%; 95% CI 82.9% to 91%) and steroids (74.7%; 95% CI 68.7% to 79.9%). Around 53.1% (95% CI 47.3% to 58.9%) required paediatric intensive care unit admissions, and overall mortality was 3.9% (95% CI 2.7% to 5.6%). Patients in MIC were younger, had a higher frequency of respiratory distress and evidence of cardiac dysfunction, with a longer hospital and intensive care unit stay and had a higher mortality rate than patients in HIC.</p><p><strong>Conclusion: </strong>MIS-C is a severe multisystem disease with better mortality outcomes in HIC as compared with MIC. 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引用次数: 0
摘要
背景：人们对儿童多系统炎症综合征（MIS-C）的认识在不断发展，但缺乏基于证据的标准化诊断和管理方案。我们的综述旨在总结儿童多系统炎症综合征（MIS-C）的临床和诊断特征、管理策略和结果，并评估高收入国家（HIC）和中等收入国家（MIC）在疾病参数和结果方面的差异：我们检索了 2019 年 12 月至 2023 年 3 月期间的四个数据库。方法：我们检索了 2019 年 12 月至 2023 年 3 月期间的四个数据库，纳入了样本量为 10 例或更多患者的观察性研究。采用混合广义线性模型来考虑异质性，并通过漏斗图和Doi图评估发表偏倚。主要结果是MIS-C患者的汇总平均死亡率。根据研究国家的收入状况进行了分组分析：共有 120 项研究（20 881 个病例）被纳入综述。最常见的临床表现为发热（99%；95% CI 99.6%至100%）、胃肠道症状（76.7%；95% CI 73.1%至79.9%）和皮肤症状（63.3%；95% CI 58.7%至67.7%）。实验室检查显示炎症、凝血和心脏标志物升高。最常见的治疗策略是静脉注射免疫球蛋白（87.5%；95% CI 82.9%至91%）和类固醇（74.7%；95% CI 68.7%至79.9%）。约53.1%（95% CI为47.3%至58.9%）的患者需要入住儿科重症监护室，总体死亡率为3.9%（95% CI为2.7%至5.6%）。与HIC患者相比，MIC患者更年轻，出现呼吸窘迫和心功能不全的频率更高，住院时间和重症监护室住院时间更长，死亡率更高：MIS-C是一种严重的多系统疾病，与MIC相比，HIC患者的死亡率更高。结论：MIS-C 是一种严重的多系统疾病，与 MIC 相比，HIC 患者的死亡率更高。研究结果强调了标准化方案和进一步研究的必要性，以优化患者护理并解决 HIC 和 MIC 之间的差异：CRD42020195823。
Clinical presentation, diagnosis and management of multisystem inflammatory syndrome in children (MIS-C): a systematic review.
Background: Knowledge about multisystem inflammatory syndrome in children (MIS-C) is evolving, and evidence-based standardised diagnostic and management protocols are lacking. Our review aims to summarise the clinical and diagnostic features, management strategies and outcomes of MIS-C and evaluate the variances in disease parameters and outcomes between high-income countries (HIC) and middle-income countries (MIC).
Methods: We searched four databases from December 2019 to March 2023. Observational studies with a sample size of 10 or more patients were included. Mean and prevalence ratios for various variables were pooled by random effects model using R. A mixed generalised linear model was employed to account for the heterogeneity, and publication bias was assessed via funnel and Doi plots. The primary outcome was pooled mean mortality among patients with MIS-C. Subgroup analysis was conducted based on the income status of the country of study.
Results: A total of 120 studies (20 881 cases) were included in the review. The most common clinical presentations were fever (99%; 95% CI 99.6% to 100%), gastrointestinal symptoms (76.7%; 95% CI 73.1% to 79.9%) and dermatological symptoms (63.3%; 95% CI 58.7% to 67.7%). Laboratory investigations suggested raised inflammatory, coagulation and cardiac markers. The most common management strategies were intravenous immunoglobulins (87.5%; 95% CI 82.9% to 91%) and steroids (74.7%; 95% CI 68.7% to 79.9%). Around 53.1% (95% CI 47.3% to 58.9%) required paediatric intensive care unit admissions, and overall mortality was 3.9% (95% CI 2.7% to 5.6%). Patients in MIC were younger, had a higher frequency of respiratory distress and evidence of cardiac dysfunction, with a longer hospital and intensive care unit stay and had a higher mortality rate than patients in HIC.
Conclusion: MIS-C is a severe multisystem disease with better mortality outcomes in HIC as compared with MIC. The findings emphasise the need for standardised protocols and further research to optimise patient care and address disparities between HIC and MIC.
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