Multisystem Inflammatory Syndrome in pediatric COVID-19 patients: A meta-analysis

Purpose Significant numbers of children and teenagers with COVID-19 have developed a severe inflammatory condition with a Kawasaki-like disease. Some needed intensive care unit admission, and others recovered quickly. We aimed to summarize the clinical and laboratory features of patients with Kawasaki-like features diagnosed during the COVID-19 pandemic. Methods A literature search in Web of Science, PubMed, Scopus, and Science Direct up to June 30, 2020. The mean or untransformed proportion and 95%CI were estimated. Results Analysis of 15 articles (318 COVID-19 patients) revealed that the mean age was 9.10 years. Although many presented with typical Kawasaki-like features; fever (82.4%), polymorphous maculopapular exanthema (63.7%), oral mucosal changes (58.1%), conjunctival injections (56.0%), edematous extremities (40.7%), and cervical lymphadenopathy (28.5%), atypical gastrointestinal (79.4%) and neurocognitive symptoms (31.8%) were also common. They had elevated LDH, D-dimer, CRP, procalcitonin, interleukin-6, troponin I levels, and lymphopenia. Nearly 77.0% developed hypotension, and 68.1% went into shock, while 41.1% had acute kidney injury. Intensive care was needed in 73.7% of cases, 13.2% were intubated, and 37.9% required mechanical ventilation, with only one reported fatality case. Intravenous immunoglobulins and steroids were given in 87.7% and 56.9% of the patients, and anticoagulants were utilized in 67.0%. Pediatric patients were discharged after a hospital stay of, on average, 6.77 days (95%CI:4.93-8.6). Conclusion Recognizing the typical and atypical presentation of pediatric COVID-19 patients has important implications in identifying children at risk. Monitoring cardiac and renal decompensation and early interventions in patients with “multisystem inflammatory syndrome” is critical to prevent further morbidity.