1. Children's age 0 – 19 years | 1. Age <21 years |
2. Fever for ≥3 days | 2. Fever: documented ≥38.0°C ≥24 hours or reported subjective fever lasting ≥24 hours |
3. Clinical signs of multisystem involvement (at least two of the following):
Rash or bilateral non-purulent conjunctivitis, or mucocutaneous inflammation signs (oral, hands, or feet) Hypotension or shock Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated troponin/NT-proBNP). Evidence of coagulopathy (prolonged prothrombin time or partial thromboplastin time, elevated D-dimer). Acute gastrointestinal symptoms (diarrhoea, vomiting, or abdominal pain) |
3. Clinical presentation consistent with MIS-C, including all of the following:
Evidence of clinically severe illness requiring hospitalization, with multisystem (≥2) organ involvement. Cardiovascular, renal, neurologic, haematologic, gastrointestinal, or dermatologic system. |
4. Elevated markers of inflammation such as C-reactive protein, erythrocyte sedimentation rate, or procalcitonin. | 4. Laboratory incidence of inflammation including, but no limited to any of the following:
Elevated C-reactive protein, erythrocyte sedimentation rate, fibrinogen, procalcitonin, D-dimer, ferritin, lactic acid dehydrogenase, interleukin 6, neutrophils. Reduced lymphocytes, low albumin. |
5. No other obvious microbial cause of inflammation, including bacterial sepsis and staphylococcal/streptococcal toxic shock syndromes. | 5. No alternative plausible diagnoses. |
6. Evidence of COVID-19 (RT-PCR, antigen test, or serolog positive), or likely contact with patients with COVID-19. | 6. Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or exposure to a suspected or confirmed COVID-19 case within the 4 weeks prior to the onset of symptoms. |
Corticotherapy (Methylprednisolone) | ✓ | ✓ | ✓ |
Imunoglobulin | ✓ | ✓ | ✓ |
Immunomodulator Anakinra | ✓ | – | – |
Inotropic support: | + | + | – |
• Dobutamine | × | ✓ | × |
× Dopamine | ✓ | ✓ | × |
× Adrenaline | ✓ | × | × |
Anticoagulation (Enoxaparin) | ✓ | ✓ | ✓ |
Antiplatelet therapy (Aspirin) | ✓ | ✓ | ✓ |
Antibiotherapy | ✓ | ✓ | ✓ |
ACE-inhibitor (Lisinopril) | ✓ | ✓ | – |
Diuretic | |||
× Furosemide | ✓ | – | – |
× Spironolactone | ✓ | – | – |
Beta-blocant | ✓ | – | – |
Leukocytes (/uL) | 25.310 | 13.890 | 7.600 | 5.000–14.500 |
Neutrophils (%) | 88,2% | 92,4% | 82,9% | 30–75% |
Thrombocytes (/uL) | 178.000 | 141.000 | 186.000 | 150.000–450.000 |
C-reactive protein (mg/L) | 137,92 | 231,68 | 161,25 | 0–5 |
Procalcitonin (ng/mL) | 1,92 | 5,06 | 3,51 | <0,05 |
Ferritin (mcg/L) | 605 | 1518 | 670,32 | 14–124 |
IL-6 (pg/mL) | 40,36 | 350,6 | 42,42 | <7 |
NT-proBNP (pg/mL) | 48,793 | 15.802 | 2.752 | <125 |
D-dimers (ug/mL) | 1,32 | 1,55 | 0,96 | 0–0,5 |
SARS-CoV2 Ig G antibodies | Positive | Positive | Positive | – |