• Deborah A Levine, Vincent Uy, William Krief, Cara Bornstein, Dina Daswani, Darshan Patel, Marni Kriegel, Nazreen Jamal, Kavita Patel, Tian Liang, Alexander Arroyo, Christopher Strother, Czer Anthoney Lim, Melissa L Langhan, Ameer Hassoun, Haamid Chamdawala, Carl Philip Kaplan, Muhammad Waseem, Ee Tein Tay, David Mortel, Adam B Sivitz, Christopher Kelly, Horton James Lee, Yuqing Qiu, Mark Gorelik, Shari L Platt, and Peter Dayan.
• From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York.
• Pediatr Emerg Care. 2023 Aug 1; 39 (8): 555561555-561.

ObjectivesPatients with multisystem inflammatory disease in children (MIS-C) are at risk of developing shock. Our objectives were to determine independent predictors associated with development of delayed shock (≥3 hours from emergency department [ED] arrival) in patients with MIS-C and to derive a model predicting those at low risk for delayed shock.MethodsWe conducted a retrospective cross-sectional study of 22 pediatric EDs in the New York City tri-state area. We included patients meeting World Health Organization criteria for MIS-C and presented April 1 to June 30, 2020. Our main outcomes were to determine the association between clinical and laboratory factors to the development of delayed shock and to derive a laboratory-based prediction model based on identified independent predictors.ResultsOf 248 children with MIS-C, 87 (35%) had shock and 58 (66%) had delayed shock. A C-reactive protein (CRP) level greater than 20 mg/dL (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 2.4-12.1), lymphocyte percent less than 11% (aOR, 3.8; 95% CI, 1.7-8.6), and platelet count less than 220,000/uL (aOR, 4.2; 95% CI, 1.8-9.8) were independently associated with delayed shock. A prediction model including a CRP level less than 6 mg/dL, lymphocyte percent more than 20%, and platelet count more than 260,000/uL, categorized patients with MIS-C at low risk of developing delayed shock (sensitivity 93% [95% CI, 66-100], specificity 38% [95% CI, 22-55]).ConclusionsSerum CRP, lymphocyte percent, and platelet count differentiated children at higher and lower risk for developing delayed shock. Use of these data can stratify the risk of progression to shock in patients with MIS-C, providing situational awareness and helping guide their level of care.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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