Table 1.
MIS-C patient characterization
Moderate MIS-C (n = 6)Severe MIS-C (n = 8)All (n = 14)P valuea
Demographics 
Females, n (%) 3 (50) 4 (50) 7 (50) 1.000 
Age, yr, median (IQR) 10 (9–11.75) 10 (7.75–14.25) 10 (8.25–13.5) 0.755 
Race/ethnicity 
White/Caucasian, n (%) 3 (50) 2 (25) 5 (35) 0.514 
African/Black, n (%) 2 (33) 2 (25) 4 (28)  
Asian/Middle Eastern, n (%) 1 (16) 2 (25) 3 (21)  
Other, n (%) 0 (0) 2 (25) 2 (14)  
BMI, median (IQR) 16.4 (16.1–18.1) 19.1 (16.5–20.6) 17.8 (16.1–20.3) 0.491 
Admission data 
ICU stay, median days (IQR) 2 (1.7–2) 5.5 (4–7) 4 (2–6.2) 0.004 
Hospital stay, median days (IQR) 7.5 (7–8) 12.5 (9.7–13) 9 (7.2–12.7) 0.008 
PIM2 score, median (IQR) 1.3 (1.1–1.6) 7.9 (7.5–11.8) 7.3 (1.6–7.9) 0.002 
PRISM score, median (IQR) 0 (0–2.25) 3 (1.5–6) 2 (0–4) 0.135 
pSOFA score, median (IQR) 0.5 (0–1) 4.5 (4–6) 3.5 (1–4.8) <0.001 
Presenting symptoms 
Fever, median days (IQR) 6.5 (6–7.7) 6 (6–6.2) 6 (6–7) 0.573 
Upper respiratory tract infection, n (%) 0 (0) 2 (25) 2 (14) 0.186 
(Secondary) respiratory distress, n (%) 0 (0) 5 (62) 5 (35) 0.016 
Gastrointestinal, n (%) 6 (100) 8 (100) 14 (100) 1.000 
Abdominal pain, n (%) 4 (66) 8 (100) 12 (85) 0.078 
Vomiting, n (%) 4 (66) 5 (62) 9 (64) 0.872 
Diarrhea, n (%) 3 (50) 3 (37) 6 (42) 0.640 
Myalgia, n (%) 1 (16) 2 (25) 3 (21) 0.707 
Headache, n (%) 3 (50) 3 (37) 6 (42) 0.640 
Encephalopathy, n (%) 0 (0) 2 (25) 2 (14) 0.186 
Kawasaki criteria 
Incomplete KD, n (%) 2 (33) 7 (87) 9 (64) 0.036 
Complete KD, n (%) 2 (33) 0 (0) 2 (14) 0.078 
Fever ≥5 d, n (%) 5 (83) 7 (87) 12 (85) 0.825 
Extremity changes, n (%) 2 (33) 1 (12) 3 (21) 0.347 
Exanthema, n (%) 3 (50) 6 (75) 9 (64) 0.334 
Non-exudative conjunctivitis, n (%) 4 (66) 7 (87) 11 (78) 0.347 
Lip or mouth changes, n (%) 4 (66) 3 (37) 7 (50) 0.280 
Cervical lymphadenopathy, n (%) 3 (50) 2 (25) 5 (35) 0.334 
Cardiac ultrasound 
Hyperechogenicity, n (%) 2 (33) 1 (12) 3 (21) 0.347 
Prominent coronaries without dilatation, n (%) 3 (50) 1 (12) 4 (28) 0.124 
Coronary dilatation, n (%) 0 (0) 2 (25) 2 (14) 0.186 
Decreased LV function (FS <25%), n (%) 0 (0) 4 (50) 4 (28) 0.091 
Association with SARS-CoV-2 
Previous SARS-CoV-2 contact (suspect or confirmed), n (%) 5 (83) 5 (62) 10 (71) 0.393 
Interval between first contact and onset symptoms, range 4–6 wk 11 d–6 wk 11 d–6 wk  
First positive nasopharyngeal SARS-CoV-2 RT-PCR 
 Prior to MIS-C presentation, n (%) 1 (16) 1 (12) 2 (14) 0.825 
 At admission, n (%) 0 (0) 1 weak positive (Ct 34) (12) 1 (7) 0.369 
IgG positive (tested during admission) 5 (83) 8 (100) 13 (92) 0.231 
Laboratory markers during admission 
ESR (max), median (IQR), mm/U 87 (48–109.5) 20 (18–29.5) 42 (20–108) 0.095 
Hb (min), median (IQR), g/dl 9.3 (8.4–10.2) 9.2 (8.5–10) 9.2 (8.3–10.1) 0.755 
WBC (max), median (IQR), × 109/liter 7.9 (7.86–15.04) 15.51 (14.83–20.4) 15.03 (8.8–17.53) 0.081 
Lymphocytes (min), median (IQR), × 109/liter 0.63 (0.4–0.76) 0.28 (0.24–0.4) 0.37 (0.26–0.57) 0.029 
Neutrophils (max), median (IQR), × 109/liter 6.75 (6.42–10.01) 13.49 (12.63–17.09) 12.27 (7.47–14.7) 0.020 
Eosinophils (min), median (IQR), × 109/liter 0.07 (0.02–0.1) 0 (0–0.01) 0.01 (0–0.05) 0.029 
Platelets (min), median (IQR), × 109/liter 162 (148–189) 138 (77–192) 153 (88–193) 0.662 
Creatinine (max), median (IQR), mg/dl 0.62 (0.54–0.72) 0.78 (0.53–1.19) 0.71 (0.53–1.09) 0.512 
Urea (max), median (IQR), mg/dl 29 (21–48) 60 (43–76) 47 (36–68) 0.056 
AST (max), median (IQR), U/liter 44 (34–60) 54 (43–94) 49 (37–70) 0.445 
ALT (max), median (IQR), U/liter 46 (35–53) 68 (61–86) 55 (43–68) 0.073 
GGT (max), median (IQR), U/liter 45 (27–52) 75 (55–102) 55 (44–77) 0.022 
Ferritin (max), median (IQR), µg/liter 531 (240.5–608.5) 703 (557.3–885.3) 592.5 (510.8–858,8) 0.282 
Fibrinogen (max), median (IQR), mg/dl 606.5 (453.3–757.5) 660.5 (460–741.8) 660.5 (452–759.3) 1.000 
D-dimer (max), median (IQR), ng/ml 2,906 (2,286–3,700) 3,920 (2,430–4,945) 3,190 (2,174–4,420) 0.534 
CRP (max), median (IQR), mg/liter 189.3 (178.3–193.8) 324.3 (289–390.6) 286.4 (187.3–376.1) 0.142 
hsTrop (max), median (IQR), pg/ml 35 (7.5–114.63) 193 (77–1,980) 77 (47.2–278.5) 0.352 
NT-proBNP (max), median (IQR), pg/ml 507 (506–507) 5,333 (3,142–8,752) 3,142 (846–7,043) 0.095 
Treatment 
Low-flow nasal cannula oxygen, n (%) 0 (0) 8 (100) 8 (57) <0.001 
High-flow nasal cannula oxygen, n (%) 0 (0) 5 (62) 5 (35) 0.016 
Mechanical ventilation, n (%) 0 (0) 0 (0) 0 (0) 1.000 
Inotropics, n (%) 0 (0) 8 (100) 8 (57) <0.001 
IVIG, n (%) 6 (100) 5 (62) 11 (78) 0.091 
Corticosteroids, n (%) 2 (33) 7 (87) 9 (64) 0.036 
Combination IVIG and corticosteroids 2 (33) 4 (50) 6 (42) 0.533 
Acetylsalicylic acid, n (%) 4 (66) 5 (62) 9 (64) 0.872 
Antibiotics, n (%) 6 (100) 8 (100) 14 (100) 1.000 
Biologicals, n (%) 0 (0) 0 (0) 0 (0) 1.000 
Outcome 
Alive at follow-up, n (%) 6 (100) 8 (100) 14 (100) 1.000 
No residual morbidity, n (%) 0 (0) 0 (0) 0 (0) 1.000 
Moderate MIS-C (n = 6)Severe MIS-C (n = 8)All (n = 14)P valuea
Demographics 
Females, n (%) 3 (50) 4 (50) 7 (50) 1.000 
Age, yr, median (IQR) 10 (9–11.75) 10 (7.75–14.25) 10 (8.25–13.5) 0.755 
Race/ethnicity 
White/Caucasian, n (%) 3 (50) 2 (25) 5 (35) 0.514 
African/Black, n (%) 2 (33) 2 (25) 4 (28)  
Asian/Middle Eastern, n (%) 1 (16) 2 (25) 3 (21)  
Other, n (%) 0 (0) 2 (25) 2 (14)  
BMI, median (IQR) 16.4 (16.1–18.1) 19.1 (16.5–20.6) 17.8 (16.1–20.3) 0.491 
Admission data 
ICU stay, median days (IQR) 2 (1.7–2) 5.5 (4–7) 4 (2–6.2) 0.004 
Hospital stay, median days (IQR) 7.5 (7–8) 12.5 (9.7–13) 9 (7.2–12.7) 0.008 
PIM2 score, median (IQR) 1.3 (1.1–1.6) 7.9 (7.5–11.8) 7.3 (1.6–7.9) 0.002 
PRISM score, median (IQR) 0 (0–2.25) 3 (1.5–6) 2 (0–4) 0.135 
pSOFA score, median (IQR) 0.5 (0–1) 4.5 (4–6) 3.5 (1–4.8) <0.001 
Presenting symptoms 
Fever, median days (IQR) 6.5 (6–7.7) 6 (6–6.2) 6 (6–7) 0.573 
Upper respiratory tract infection, n (%) 0 (0) 2 (25) 2 (14) 0.186 
(Secondary) respiratory distress, n (%) 0 (0) 5 (62) 5 (35) 0.016 
Gastrointestinal, n (%) 6 (100) 8 (100) 14 (100) 1.000 
Abdominal pain, n (%) 4 (66) 8 (100) 12 (85) 0.078 
Vomiting, n (%) 4 (66) 5 (62) 9 (64) 0.872 
Diarrhea, n (%) 3 (50) 3 (37) 6 (42) 0.640 
Myalgia, n (%) 1 (16) 2 (25) 3 (21) 0.707 
Headache, n (%) 3 (50) 3 (37) 6 (42) 0.640 
Encephalopathy, n (%) 0 (0) 2 (25) 2 (14) 0.186 
Kawasaki criteria 
Incomplete KD, n (%) 2 (33) 7 (87) 9 (64) 0.036 
Complete KD, n (%) 2 (33) 0 (0) 2 (14) 0.078 
Fever ≥5 d, n (%) 5 (83) 7 (87) 12 (85) 0.825 
Extremity changes, n (%) 2 (33) 1 (12) 3 (21) 0.347 
Exanthema, n (%) 3 (50) 6 (75) 9 (64) 0.334 
Non-exudative conjunctivitis, n (%) 4 (66) 7 (87) 11 (78) 0.347 
Lip or mouth changes, n (%) 4 (66) 3 (37) 7 (50) 0.280 
Cervical lymphadenopathy, n (%) 3 (50) 2 (25) 5 (35) 0.334 
Cardiac ultrasound 
Hyperechogenicity, n (%) 2 (33) 1 (12) 3 (21) 0.347 
Prominent coronaries without dilatation, n (%) 3 (50) 1 (12) 4 (28) 0.124 
Coronary dilatation, n (%) 0 (0) 2 (25) 2 (14) 0.186 
Decreased LV function (FS <25%), n (%) 0 (0) 4 (50) 4 (28) 0.091 
Association with SARS-CoV-2 
Previous SARS-CoV-2 contact (suspect or confirmed), n (%) 5 (83) 5 (62) 10 (71) 0.393 
Interval between first contact and onset symptoms, range 4–6 wk 11 d–6 wk 11 d–6 wk  
First positive nasopharyngeal SARS-CoV-2 RT-PCR 
 Prior to MIS-C presentation, n (%) 1 (16) 1 (12) 2 (14) 0.825 
 At admission, n (%) 0 (0) 1 weak positive (Ct 34) (12) 1 (7) 0.369 
IgG positive (tested during admission) 5 (83) 8 (100) 13 (92) 0.231 
Laboratory markers during admission 
ESR (max), median (IQR), mm/U 87 (48–109.5) 20 (18–29.5) 42 (20–108) 0.095 
Hb (min), median (IQR), g/dl 9.3 (8.4–10.2) 9.2 (8.5–10) 9.2 (8.3–10.1) 0.755 
WBC (max), median (IQR), × 109/liter 7.9 (7.86–15.04) 15.51 (14.83–20.4) 15.03 (8.8–17.53) 0.081 
Lymphocytes (min), median (IQR), × 109/liter 0.63 (0.4–0.76) 0.28 (0.24–0.4) 0.37 (0.26–0.57) 0.029 
Neutrophils (max), median (IQR), × 109/liter 6.75 (6.42–10.01) 13.49 (12.63–17.09) 12.27 (7.47–14.7) 0.020 
Eosinophils (min), median (IQR), × 109/liter 0.07 (0.02–0.1) 0 (0–0.01) 0.01 (0–0.05) 0.029 
Platelets (min), median (IQR), × 109/liter 162 (148–189) 138 (77–192) 153 (88–193) 0.662 
Creatinine (max), median (IQR), mg/dl 0.62 (0.54–0.72) 0.78 (0.53–1.19) 0.71 (0.53–1.09) 0.512 
Urea (max), median (IQR), mg/dl 29 (21–48) 60 (43–76) 47 (36–68) 0.056 
AST (max), median (IQR), U/liter 44 (34–60) 54 (43–94) 49 (37–70) 0.445 
ALT (max), median (IQR), U/liter 46 (35–53) 68 (61–86) 55 (43–68) 0.073 
GGT (max), median (IQR), U/liter 45 (27–52) 75 (55–102) 55 (44–77) 0.022 
Ferritin (max), median (IQR), µg/liter 531 (240.5–608.5) 703 (557.3–885.3) 592.5 (510.8–858,8) 0.282 
Fibrinogen (max), median (IQR), mg/dl 606.5 (453.3–757.5) 660.5 (460–741.8) 660.5 (452–759.3) 1.000 
D-dimer (max), median (IQR), ng/ml 2,906 (2,286–3,700) 3,920 (2,430–4,945) 3,190 (2,174–4,420) 0.534 
CRP (max), median (IQR), mg/liter 189.3 (178.3–193.8) 324.3 (289–390.6) 286.4 (187.3–376.1) 0.142 
hsTrop (max), median (IQR), pg/ml 35 (7.5–114.63) 193 (77–1,980) 77 (47.2–278.5) 0.352 
NT-proBNP (max), median (IQR), pg/ml 507 (506–507) 5,333 (3,142–8,752) 3,142 (846–7,043) 0.095 
Treatment 
Low-flow nasal cannula oxygen, n (%) 0 (0) 8 (100) 8 (57) <0.001 
High-flow nasal cannula oxygen, n (%) 0 (0) 5 (62) 5 (35) 0.016 
Mechanical ventilation, n (%) 0 (0) 0 (0) 0 (0) 1.000 
Inotropics, n (%) 0 (0) 8 (100) 8 (57) <0.001 
IVIG, n (%) 6 (100) 5 (62) 11 (78) 0.091 
Corticosteroids, n (%) 2 (33) 7 (87) 9 (64) 0.036 
Combination IVIG and corticosteroids 2 (33) 4 (50) 6 (42) 0.533 
Acetylsalicylic acid, n (%) 4 (66) 5 (62) 9 (64) 0.872 
Antibiotics, n (%) 6 (100) 8 (100) 14 (100) 1.000 
Biologicals, n (%) 0 (0) 0 (0) 0 (0) 1.000 
Outcome 
Alive at follow-up, n (%) 6 (100) 8 (100) 14 (100) 1.000 
No residual morbidity, n (%) 0 (0) 0 (0) 0 (0) 1.000 

Bold and italic text indicates that P values are <0.05 and are considered significant. BMI, body mass index; ESR, erythrocyte sedimentation rate; FS, fractional shortening; Hb, hemoglobin; ICU, intensive care unit; LV, left ventricular; min, minimum; max, maximum; NT-proBNP, N-terminal pro-brain natriuretic peptide; PRISM, pediatric risk of mortality; pSOFA, pediatric sequential organ failure assessment.

a

Chi-square test (two-sided) for categorical variables, Mann–Whitney U for continuous variables, tested between moderate and severe MIS-C.

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