474. Unique Treatment Challenges with Multisystem Inflammatory Syndrome in Children (MIS-C) compared to Kawasaki Disease Shock Syndrome

Abstract Background Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Coronavirus Disease 2019 present similarly with mucocutaneous symptoms and fever. Both syndromes can progress to shock. Successful treatments for MIS-C are largely based on proven KD management. As more patients with MIS-C are treated, protocols are adjusted. Infectious Diseases (ID) specialists are often early consultants in these cases. Understanding differences in how body systems are affected in MIS-C versus KD is essential for management. Figure 1. Cardiac changes among patients with Kawasaki Disease shock syndrome (KDSS) and Muti-system Inflammatory Syndrome (MIS-C) Methods This is a single hospital comparison of 25 cases of MIS-C with mucocutaneous presentation and symptoms of shock and 25 consecutive cases of KD Shock Syndrome (KDSS). Cases were compared for demographics, symptoms, cardiac abnormalities, medical treatments, and cardiac recovery. Results Patients with MIS-C develop symptoms of shock including sustained hypotension and tachycardia at 3 times the rate of patients with KD (45% vs 13%; p< 0.001). On echocardiogram, left ventricular myocardial dysfunction, assessed by ejection fraction, is more commonly noted in cases of MIS-C than KDSS (fig 1). About half of patients with MIS-C show left ventricular myocardial dysfunction initially with normalization by 6 months post-presentation in the majority (96%). Conclusion Cardiac changes and shock events related to KD and MIS-C are thought to be caused by differing inflammatory mediators. By comparing these two syndromes, we can determine ways to manage each optimally. MIS-C often results in left ventricular myocardial dysfunction, which is rarer in KD cases. Fluid resuscitation with multiple fluid boluses followed by inotropes to treat hypotension in cases of in MIS-C puts increased strain on the already weakened myocardium. Early intravenous immunoglobulin (IVIG) administration, even in the presence of mild hypotension, can simultaneously provide the patient with additional fluid and decrease the underlying inflammatory process. This prompt treatment might reduce the need for pressor support while protecting the myocardium from further damage. As early consultants in MIS-C, ID providers should be educated regarding the unique cardiac challenges of MIS-C and avoid delay in IVIG treatment and cardiologist and intensivist consultation. Disclosures All Authors: No reported disclosures

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Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain

Frontiers in Pediatrics ◽

10.3389/fped.2020.617039 ◽

2021 ◽

Vol 8 ◽

Author(s):

Elisa Fernández-Cooke ◽

Carlos D. Grasa ◽

Sara Domínguez-Rodríguez ◽

Ana Barrios Tascón ◽

Judith Sánchez-Manubens ◽

...

Keyword(s):

Kawasaki Disease ◽

Clinical Characteristics ◽

Myocardial Dysfunction ◽

Clinical Signs ◽

Pediatric Intensive Care ◽

Terminal Segment ◽

C Reactive Protein ◽

Reactive Protein ◽

Aneurysm Development ◽

Inflammatory Syndrome

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain.Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1–May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV–) to those from the same period during 2018 and 2019 (PreCoV).Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period.Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.

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Autoantibodies Detected in MIS-C Patients due to Administration of Intravenous Immunoglobulin

10.1101/2021.11.03.21265769 ◽

2021 ◽

Author(s):

Peter D. Burbelo ◽

Riccardo Castagnoli ◽

Chisato Shimizu ◽

Ottavia M. Delmonte ◽

Kerry Dobbs ◽

...

Keyword(s):

Kawasaki Disease ◽

Intravenous Immunoglobulin ◽

High Dose ◽

Autoantibody Production ◽

Autoantibody Profile ◽

Insulin Dependent ◽

Inflammatory Syndrome ◽

High Dose Ivig ◽

Ivig Administration

The autoantibody profile associated with known autoimmune diseases in patients with COVID-19 or multisystem inflammatory syndrome in children (MIS-C) remains poorly defined. Here we show that adults with COVID-19 had a moderate prevalence of autoantibodies against the lung antigen KCNRG, and SLE-associated Smith autoantigen. Children with COVID-19 rarely had autoantibodies; one of 59 children had GAD65 autoantibodies associated with acute insulin-dependent diabetes. While autoantibodies associated with SLE/Sjogren syndrome (Ro52, Ro60, and La) and/or autoimmune gastritis (gastric ATPase) were detected in 74% (40/54) of MIS-C patients, further analysis of these patients and of children with Kawasaki disease (KD), showed that the administration of intravenous immunoglobulin (IVIG) was largely responsible for detection of these autoantibodies in both groups of patients. Monitoring in vivo decay of the autoantibodies in MIS-C children showed that the IVIG-derived Ro52, Ro60, and La autoantibodies declined to undetectable levels by 45-60 days, but gastric ATPase autoantibodies declined more slowly requiring >100 days until undetectable. Together these findings demonstrate that administration of high-dose IVIG is responsible for the detection of several autoantibodies in MIS-C and KD. Further studies are needed to investigate autoantibody production in MIS-C patients, independently from IVIG administration.

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KAWASAKI DISEASE AND MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN WITH COVID-19 INFECTION

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2020-99-6-209-219 ◽

2020 ◽

Vol 99 (6) ◽

pp. 209-219

Author(s):

L.V. Bregel ◽

◽

M.M. Kostik ◽

L.Z. Fell ◽

O.S. Efremova ◽

...

Keyword(s):

Kawasaki Disease ◽

Hemophagocytic Syndrome ◽

Early Recognition ◽

Gastrointestinal Symptoms ◽

The United States ◽

Interleukin 10 ◽

Left Ventricular ◽

Urgent Care ◽

High Dose ◽

Inflammatory Syndrome

During the COVD-19 pandemic, some pediatric patients in many countries around the world experienced a syndrome resembling a severe Kawasaki disease (KD), often accompanied by shock. Due to the incomplete signs of the classic KD in the era before the present pandemic, in many publications from European countries and the United States, this condition was called «multisystem inflammatory syndrome in children – MIS-C» or «hyperinflammatory shock» or «Kawasaki-like syndrome». This syndrome with a new coronavirus infection is characterized by refractory fever, frequent gastrointestinal symptoms, heart damage (including coronary dilation in some patients, and acute left ventricular failure in the majority), increased ESR and CRP levels, neutrophilia, extremely high troponin levels, increased ferritin, AST, ALT, lactate dehydrogenase, creatine phosphate kinase, interleukin-6 and interleukin-10, coagulopathy with an increase in D-dimer and fibrinogen, thrombocytopenia, sometimes procalcitonin increase. The manifestations of a cytokine storm may meet the criteria for secondary hemophagocytic syndrome. The mechanism of myocardial damage remains unclear. Treatment with high-dose intravenous immunoglobulin is effective, and in the presence of signs of hemophagocytic syndrome, dexamethasone or methylprednisolone. Further research is needed to understand the pathogenesis, resemblance and differences of this syndrome with classic KD, understanding of heart injuiry and early recognition for the need of urgent care.

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Multisystem Inflammatory Syndrome in Children Associated with COVID-19: An Interim Review

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0041-1729182 ◽

2021 ◽

Author(s):

Jyoti R. Behera ◽

Mukesh K. Jain ◽

Sanjay K. Sahu ◽

Sibabratta Patnaik

Keyword(s):

Toxic Shock Syndrome ◽

Inflammatory Markers ◽

Myocardial Dysfunction ◽

Treatment Plan ◽

Left Ventricular ◽

World Health ◽

Left Ventricular Ejection ◽

Toxic Shock ◽

Ventricular Ejection Fraction ◽

Inflammatory Syndrome

AbstractThe pediatric population is relatively less affected by novel coronavirus disease 2019 (COVID-19) compared with adults, both in numbers and severity. However, evolution of a new entity, named multisystem inflammatory syndrome in children (MIS-C), has led to significant number of children being admitted to hospital, especially to intensive care units. Case definitions of MIS-C have been defined by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) separately. Autoantibodies and antibody-dependent enhancement (ADE) are the key factors proposed in pathogenesis, leading to immune dysregulation, and cytokine storm. Three distinct clinical types are observed as follows: (1) fever and elevated inflammatory markers with no end-organ damage; (2) shock with severe myocardial dysfunction similar to toxic shock syndrome (TSS); and (3) with mucocutaneous features like Kawasaki's disease (KD). Cardiovascular and gastrointestinal symptoms are the predominant presentations. Inflammatory markers like C-reactive protein (CRP), ferritin, and interleukin (IL)-6 are raised along with high D-dimer and lactate dehydrogenase (LDH). Echocardiography may demonstrate low left ventricular ejection fraction (<50%) and/or coronary aneurysms. Reverse-transcription polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is usually negative, with most having antibodies against the virus. KD, KD shock syndrome (KDSS), and toxic shock syndrome (TSS) are the important differential diagnoses to be considered. Immunomodulatory therapy is the cornerstone of the management. Intravenous immunoglobulin (IVIg) is preferred, the next option being steroids. Supportive care, antiplatelet, and anticoagulation medications, when indicated, are also vital aspects of treatment plan. The prognosis is favorable with low mortality but meticulous cardiac monitoring and follow-up by a multidisciplinary team is very important. Being an evolving disease, future research may reveal different manifestations, newer diagnostic modalities, and better treatment options.

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Evaluation of myocardial function using the Tei index in patients with Kawasaki disease

Cardiology in the Young ◽

10.1017/s1047951109991910 ◽

2009 ◽

Vol 20 (1) ◽

pp. 44-48 ◽

Cited By ~ 10

Author(s):

Gholamhossein Ajami ◽

Mohammad Borzouee ◽

Hamid Amoozgar ◽

Feridoon Ashnaee ◽

Sara Kashef ◽

...

Keyword(s):

Kawasaki Disease ◽

Acute Phase ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Myocardial Function ◽

Myocardial Dysfunction ◽

Left Ventricular ◽

Healthy Children ◽

Tei Index ◽

Systolic And Diastolic Function

AbstractMyocarditis is a well-recognized component of Kawasaki disease, with left ventricular dysfunction occurring in more than half of the patients during the acute phase of the disease. The purpose of our study was to evaluate myocardial function in these patients using the myocardial performance index, also known as the Tei index. In a prospective study, 14 patients underwent echocardiographic evaluation, first at the time of diagnosis of the disease, in its acute phase before treatment with intravenous immunoglobulin and then 2 weeks later after treatment with immunoglobulin. We assessed the Tei-index, the ejection fraction, shortening fraction, and the presence of valvar regurgitation, pericardial effusion, or coronary arterial involvement. As a control, we also assessed 22 healthy children, matched for age and sex with the study population. Of the patients, half had an increased left ventricular Tei-index in the acute phase, as compared with the data obtained after treatment, the index changing from 0.43 ± 0.08 to 0.35 ± 0.06 (p equal to 0.003). An increased index for the right ventricle was found in 5 patients (36%), values being 0.30 ± 0.05 as opposed to 0.26 ± 0.04 (p equal to 0.009). Of the patients, 5 (35.7%) also had decreased ejection fractions and proportional shortening fractions during the acute phase, confirming left ventricular dysfunction. We concluded that the Tei-index, which measures combined systolic and diastolic function, is a simple, sensitive, and accurate tool for estimating global myocardial dysfunction in patients with Kawasaki disease.

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Affinché non MIS-Cappi il caso: la sindrome infiammatoria multisistemica SARS-CoV-2-correlata

Medico e Bambino pagine elettr ◽

10.53126/mebxxiv289 ◽

2021 ◽

Vol 24 (10) ◽

pp. 289-297

Author(s):

Salvatore Giordano ◽

Ilaria Pirrone ◽

Giulia Angela Restivo ◽

Filippo Collura ◽

Giovanni Francesco Saia ◽

...

Keyword(s):

Kawasaki Disease ◽

Rare Condition ◽

Good Prognosis ◽

Left Ventricular ◽

Case Definition ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Reactive Protein ◽

Atypical Kawasaki Disease ◽

Inflammatory Syndrome

Background - Covid-19 is less frequent and milder in children than in adults. However, cases of multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (MIS-C) have been reported in children, whose phenotype resembles atypical Kawasaki disease. Objectives - The paper describes incidence as well as clinical, laboratoristic and radiological findings of MIS-C. Materials and methods - In the Paediatric Infectious Disease Centre of Palermo (Italy), a targeted surveillance for MIS-C from March 2020 to January 2021 was conducted. Case definition included WHO, UK and US criteria. Results - The paper reports the cases of 9 patients with MIS-C out of which 8 (88%) were hospitalized after September 2020. 44% were male and their median age was 6.5 years. Organ-system involvement included gastrointestinal (66%), cardiovascular (66%), mucocutaneous (88%), reticuloendothelial (77%) and respiratory (55%) systems. C-reactive protein (CRP), procalcitonin, D-dimer and pro-B-type natriuretic peptide levels (pro-BNP) were high in all patients. Chest radiography showed bilateral ground glass-opacities (55%) and pleural effusions (44%). Abdominal imaging findings included small-volume ascites (55%) and mesenteric lymphadenopathy (22%). Echocardiogram showed transient valves regurgitation (55%). In all the patients, the left ventricular ejection fraction was normal and coronary-artery aneurysms were not documented. They were treated with immunomodulating therapies. All patients neither received intensive care nor died. Conclusions - MIS-C represents a new systemic inflammatory syndrome with a phenotype resembling Kawasaki disease. MIS-C remains a rare condition, in which gastrointestinal and mucocutaneous involvement is predominant, nevertheless cardiovascular involvement must be investigated. MIS-C could be suspected even if SARS-CoV-2 exposure precedes the onset of the symptoms by more than 6 weeks. In most cases, a good prognosis might be expected.

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18F-FDG PET/CT findings in post COVID Multisystem inflammatory syndrome in adults (MIS-A)

10.21203/rs.3.rs-753812/v1 ◽

2021 ◽

Author(s):

BOBY VARKEY MARAMATTOM ◽

Geetha Philips ◽

Shagos Gopalan Nair Santhamma

Keyword(s):

Fdg Pet ◽

Myocardial Dysfunction ◽

Emission Tomography ◽

Prompt Treatment ◽

Ct Findings ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct ◽

Inflammatory Syndrome ◽

Post Infectious

Abstract We describe 18 fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET-CT) findings in a patient that inadvertently betrayed features of MIS-A. The findings were suggestive of an exaggerated Systemic inflammatory response syndrome (SIRS)- a prequel to MIS-A. MIS-A has been recently described in 2020 as a post-infectious or para-infectious sequela of COVID-19. Within 12 weeks of symptomatic or asymptomatic COVID-19 illness (diagnosed by serum SARS CoV2 antibodies), patients present with an illness requiring hospitalization that can rapidly progress to myocardial dysfunction and cardiogenic shock. (1) As with any illness, there is a period of ‘quiet before the storm’. Identification of patients early in the course of the illness and prompt treatment can improve clinical outcomes in MIS-A.

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Abstract 2341: Myocardial Ultrasound Tissue Characterisation in Children after Kawasaki disease

Circulation ◽

10.1161/circ.116.suppl_16.ii_512-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Benedetta Leonardi ◽

Vincenzo Giglio ◽

Vincenzo Pasceri ◽

Andrea de Zorzi ◽

Stephen P Sanders

Keyword(s):

Kawasaki Disease ◽

Myocardial Dysfunction ◽

Subsequent Development ◽

Left Ventricular ◽

Doppler Imaging ◽

Cellular Damage ◽

Lv Function ◽

Integrated Backscatter ◽

Ultrasound Tissue Characterization

Background: Reports of late follow-up of patients with Kawasaki Disease (KD), even with no epicardial coronary artery disease, have demonstrated abnormal vascular reactivity and myocardial perfusion. Left ventricular (LV) function is usually normal in KD patients during long-term follow-up. However, data regarding the myocardial properties of these children are lacking. Ultrasound tissue characterization (UTC), under some circumstances, appears to be predictive of subsequent development of myocardial dysfunction. Methods and Results: We performed UTC analysis in 22 asymptomatic KD patients, mean age 6.6±3.4 years, 17 males, with a mean follow-up of 4.8±3.4 years after the illness. Coronary aneurysms were present in 8 patients (mean age 7.8±5.3 years). Cyclic variation of integrated backscatter (cvIBS) and calibrated integrated backscatter (cIBS) were assessed in 16 LV myocardial segments. Tissue Doppler imaging (TDI) at the mitral annulus was performed to assess LV diastolic function. All UTC and TDI data were compared to 22 age-matched controls, mean age 6.6±3.4 years. All patients had normal LV systolic function and wall motion score index (WMSI) compared to controls (EF 60.3±4.0% vs 60.8±4.4%, p=0.64, WMSI 1 vs 1, p=NS respectively). Myocardial velocities in systole and diastole by TDI did not differ significantly between patients and controls. CvIBS and cIBS mean values showed significant differences, for all segments sampled, between patients and controls (7.8±0.8 dB vs 8.9±0.6 dB, p<0.001, and 28.6±3.2 dB vs 25.2±1.0 dB p< 0.001 respectively). Neither cvIBS nor cIBS differed significantly between patients with and without aneurysms (7.9±0.8 dB vs 7.8±0.8 dB, p=0.84, and 30.3±4.3 dB vs 27.7±2.3 dB, p=0.20 respectively). Conclusions: We detected widespread differences in myocardial physical properties between KD patients and controls late after the acute disease, despite normal LV function and independent of demonstrable coronary abnormalities. These differences could be related to cellular damage induced by occult myocardial ischemia or could represent abnormalities of small myocardial vessels. Further studies are needed to confirm these findings in a larger group of patients and to determine the clinical significance.

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Abstract O.49: Factors Associated with Development of Coronary Artery Aneurysms after Kawasaki Disease are Generally Similar for Those Treated Promptly Versus Those with Delayed or No Treatment

Circulation ◽

10.1161/circ.131.suppl_2.o49 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Mallory L Downie ◽

Cedric Manlhiot ◽

Tanveer H Collins ◽

Nita Chahal ◽

Rae S Yeung ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Blood Cell ◽

Cell Count ◽

Total Duration ◽

Ivig Treatment ◽

Blood Cell Count ◽

Coronary Artery Aneurysms ◽

Factors Associated ◽

Prompt Treatment

Introduction: While the risk is reduced, patients may develop coronary artery aneurysms (CAA) after Kawasaki disease (KD) despite receiving intravenous immunoglobulin (IVIG) within 10 days of onset of symptoms. Risk factors for CAA may differ compared to those patients with delayed or no treatment. Methods: Patients diagnosed with KD between 1990 and 2013 were included. Patients with maximum coronary artery z-scores >5 were classified as having CAA. Separate multivariable regression models were used to determine factors associated with CAA for those with vs. without prompt treatment. Results: Of 1,358 patients included, 83% were treated with IVIG within 10 days and 5.4% developed CAA. Patients who had delayed (>10 days) or no IVIG treatment were at increased odds of developing CAA (OR: 3.1, p<0.001). From 1990-2013, the proportion of patients treated promptly increased (OR: 1.05/year, p=0.006) while the total duration of fever decreased (EST: -0.10 (0.03) days/year, p=0.001). These trends were associated with a shift such that a greater proportion of the patients who developed CAA actually had been treated promptly (from <25% in 1990 to >70% in 2013, OR: 1.1/year, p=0.01). For patients with prompt treatment with IVIG, factors associated with increased odds of CAA were: longer duration of fever prior to treatment (OR: 1.2/day, p=0.04), age <1 year old (OR 3.9, p=0.001), higher pre-IVIG white blood cell count (OR: 1.05/x10 9 /L, p=0.007), lower hemoglobin (OR: 1.4/g/L, p=0.004) and non-response to the initial IVIG treatment (OR: 2.5, p<0.001). For patients with delayed or no treatment, factors associated with increased odds of CAA were: males (OR: 5.4, p=0.009), age <1 year old (OR: 29.9, p<0.001), lower red blood cell count (OR: 2.5/-0.5 x10 12 /L, p=0.01) and higher platelet count at diagnosis (OR: 1.4/100x10 12 /L, p=0.001). Additionally, delayed treatment with IVIG did not reduce the risk of CAA (OR: 1.9, p=0.28), and total duration of fever was not associated with CAA for this group (OR: 1.04/day, p=0.16). . Conclusions: Factors associated with the development of CAA are generally similar for those treated promptly vs. those with delayed or no treatment. For those with delayed diagnosis, treatment with IVIG does not appear to be effective to prevent CAA.

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Coronavirus Disease 2019-Related Multisystem Inflammatory Syndrome in Children: A Systematic Review and Meta-Analysis

Biochemistry Research International ◽

10.1155/2021/5596727 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Ji-Gan Wang ◽

Zhi-Juan Zhong ◽

Meng Li ◽

Jun Fu ◽

Yu-Heng Su ◽

...

Keyword(s):

Mortality Rate ◽

Kawasaki Disease ◽

Fixed Effects ◽

Clinical Symptoms ◽

Myocardial Dysfunction ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Musculoskeletal Symptoms ◽

Hands And Feet ◽

Inflammatory Syndrome

Background. This study aimed to describe the clinical symptoms, laboratory findings, treatment, and outcomes of coronavirus disease 2019-related multisystem inflammatory syndrome in children to provide a reference for clinical practice. Methods. We employed a literature search of databases such as PubMed, Web of Science, EMBASE, and Johns Hopkins University for articles on COVID-19-related multisystem inflammatory syndrome in children published between April 1, 2020, and January 15, 2021. High-quality articles were selected for analysis on the basis of their quality standard scores. Using R3.6.3 software, meta-analyses of random- or fixed-effects models were used to determine the prevalence of comorbidities. Subgroup analysis was also performed to determine heterogeneity. Results. A total of 57 articles (2,290 pediatric patients) were included in the study. Clinical Manifestations. :ncidences of fever, gastrointestinal symptoms, respiratory symptoms, and musculoskeletal symptoms (myalgias or arthralgias) were 99.91% (95% CI: 99.67–100%), 82.72% (95% CI: 78.19–86.81%), 53.02% (45.28–60.68%), and 14.16% (95% CI: 8.4–21.12%), respectively. The incidences of rash, conjunctival injection, lymphadenopathy, dry cracked lips, neurologic symptoms (headache, altered mental status, or confusion), swollen hands and feet, typical Kawasaki disease, and atypical Kawasaki disease were 59.34% (95% CI: 54.73–63.87%), 55.23% (95% CI: 50.22–60.19%), 27.07% (95% CI: 19.87–34.93%), 46.37% (95% CI: 39.97–52.83%), 28.87% (95% CI: 22.76–35.40%), 28.75% (95% CI: 21.46–36.64%), 17.32% (95% CI: 15.44–19.29%), and 36.19% (95% CI: 21.90–51.86%), respectively. The incidences of coronary artery dilation, aneurysm, pericardial effusion, myocarditis, myocardial dysfunction, high troponin, and N-terminal pro-B-type natriuretic peptide were 17.83%, 6.85%, 20.97%, 35.97%, 56.32%, 76.34%, and 86.65%, respectively. The incidences of reduced lymphocytes, thrombocytopenia, hypoalbuminemia, elevated C-reactive protein, ferritin, LDH, interleukin-6, PCT, and FIB were 61.51%, 26.42%, 77.92%, 98.5%, 86.79%, 80.59%, 89.30%, 85.10%, and 87.01%, respectively. PICU Hospitalization Rate and Mortality. The incidences of PICU hospitalization or with shock were 72.79% and 55.68%, respectively. The mortality rate was 1.00%. Conclusion and Relevance. PICU hospitalization and shock rates of multisystem inflammatory syndrome in children associated with COVID-19 were high, and its cumulative multiorgans and inflammatory indicators are increased, but if treated in time, the mortality rate was low.

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