Comparison of Clinical Characteristics Between Multisystem Inflammatory Syndrome in Children and Kawasaki Disease Shock Syndrome

DONG Xin; SHI Lin; ZHANG Mingming; LIN Yao; DENG Yanjun; LI Yaqi

doi:10.3969/j.issn.1674-4055.2025.12.013

Abstract：Objective This study analyzes the clinical characteristics of multisystem inflammatory syndrome in children(MIS-C)and Kawasaki disease shock syndrome(KDSS),summarizes and identifies their main features,providing a basis for timely and accurate diagnosis and treatment.Methods Clinical data were retrospectively collected from 12 children diagnosed with multisystem inflammatory syndrome in children(MIS-C)at Capital Center for Children's Health,Capital Medical University from January to February 2023,and 38 children diagnosed with Kawasaki disease shock syndrome(KDSS)from January 2018 to December 2023.Demographic characteristics,clinical manifestations,complications,laboratory parameters(including white blood cell count,neutrophil count,platelet count,high-sensitivity cardiac troponin T,tumor necrosis factor-α,and interleukin-8)and treatment strategies were compared between the two groups.Binary logistic regression analysis was conducted to identify key diagnostic indicators useful for differentiating MIS-C from KDSS,and receiver operating characteristic(ROC)curves were used to evaluate their diagnostic performance.Results Among the 12 children with MIS-C,5 were male and 7 were female;among the 38 children with KDSS,18 were male and 20 were female.There were no statistically significant differences between the two groups regarding sex and age(P>0.05).The incidence rates of polymorphic rash(50.00%vs.84.21%),lymphadenopathy(75.00%vs.100.00%),non-purulent conjunctivitis(66.67%vs.94.74%),and erythema or induration of the extremities(33.33%vs.81.58%)were significantly lower in the MIS-C group compared with the KDSS group(P<0.05).Shock occurred significantly earlier in the MIS-C group than in the KDSS group[(5.58 ± 1.38)days vs.(6.47 ± 1.18)days,P=0.033].The incidence rates of myocardial injury(83.33%vs.34.21%,P=0.006),decreased left ventricular ejection fraction(50.00%vs.5.26%,P=0.001),and high-grade atrioventricular block(25.00%vs.2.63%,P=0.038)were significantly higher in the MIS-C group compared with the KDSS group.Although the incidence of coronary artery dilatation was lower in the MIS-C group(25.00%vs.44.74%),the difference was not statistically significant(P>0.05).Laboratory findings showed that levels of high-sensitivity cardiac troponin T,tumor necrosis factor-α,and interleukin-8 were significantly higher in the MIS-C group than in the KDSS group(P<0.05),whereas white blood cell count,platelet count,absolute CD3+T cell count,absolute CD16+CD56+natural killer cell count,and absolute lymphocyte count were significantly lower in the MIS-C group(P<0.05).Neutrophil and alanine aminotransferase levels were significantly higher in the KDSS group compared with the MIS-C group(P<0.05).The rates of methylprednisolone pulse therapy and the use of vasoactive agents were significantly higher in the MIS-C group compared with the KDSS group(P<0.05).Binary logistic regression analysis indicated that interleukin-8(OR=1.03,95%CI:1.004～1.055,P<0.05)and high-sensitivity cardiac troponin T(OR=1.15,95%CI:1.030～1.281,P<0.05)were useful diagnostic predictors for differentiating MIS-C from KDSS.Conclusion Compared with the KDSS group,shock occurred significantly earlier in the MIS-C group.Cardiovascular complications in MIS-C were characterized predominantly by myocardial injury,reduced left ventricular ejection fraction,and high-grade atrioventricular block rather than coronary artery lesions.Treatment of MIS-C more frequently required pulse-dose corticosteroids and vasoactive agents.Patients with interleukin-8 levels>72.1 pg/mL and high-sensitivity cardiac troponin T levels>14.5 ng/L were more likely to be diagnosed with MIS-C.