Cardiovascular involvement in multisystem inflammatory syndrome in children and midterm follow-up from a pediatric tertiary center in India

Table 1 Univariate analysis of clinical and laboratory parameters in those with and without cardiac involvement, n (%)

Clinical parameters	With cardiac involvement (n = 211)	Without cardiac involvement (n = 59)	Odds ratio (95%CI)	P value
Gender (female)	94 (78)	26 (21.6)	0.98 (0.52-1.82)	0.534
Pain abdomen	103 (48.80)	29 (49.97)	0.986 (0.55-1.766)	0.54
Altered sensorium	78 (36.97)	12 (20.34)	2.29 (1.164-4.745)	0.010
Breathlessness	64 (30.3)	4 (6.78)	5.95 (2.231-20.06)	< 0.001
Cracked lips	94 (44.55)	21 (35.59)	1.45 (0.800-2.676)	0.139
Diarrhea	195 (77.21)	31 (52.54)	0.895 (0.499-1.600)	0.409
Edema	100 (47.39)	17 (28.81)	2.22 (1.197-4.232)	0.007
Fever (> 38 °C)	209 (99.0)	56 (94.92)	5.55 (0.622-67.95)	0.071
Oliguria	43 (20.38)	5 (2.47)	2.75 (1.019-9.36)	0.022
Rash	97 (45.97)	33 (55.93)	0.671 (0.358-1.247)	0.113
Red eye	129 (61.14)	36 (61.02)	1.005 (0.55-1.815)	0.55
Red lips	80 (37.91)	22 (37.29)	1.02 (0.56-1.88)	0.528
Vomiting	161 (76.3)	45 (76.27)	1.008 (0.49-1.95)	0.559
Non-rebreathing mask	96 (45.71)	0	Undefined	< 0.001
Hi-flow nasal cannula	51 (24.17)	1 (1.92)	18.3 (3.4-382.5)	< 0.001
Bilevel positive airway pressure	16 (7.88)	1 (1.69)	4.94 (0.86-106.8)	0.07
Invasive ventilation	53 (25.24)	0	Undefined	0.001
Thrombocytopenia	108 (51.18)	14 (24.14)	3.28 (1.711-6.52)	< 0.001
Thrombocytosis	62 (29.52)	17 (28.81)	1.03 (0.55-1.994)	0.527
Anemia	128 (60.66)	11 (28.81)	3.79 (2.04-7.248)	< 0.001
Hyponatremia	170 (80.59)	36 (61.01)	2.638 (1.401-4.938)	0.002
Continuous variables
Age (years)	6 (2-9)	5 (2.5-9)		0.912
Heart rate/minute	130 (112-150)	110 (100-130)		< 0.001
C-reactive protein (mg/L)	48 (12-112)_	48 (12-137)		0.785
Erythrocyte sedimentation rate (mm/hour)	45 (28-80)	49.5 (31-88)		0.49
Highest platelet count (103/L)	294 (178-486)	343 (215-502)		0.132
Lowest platelet count (103/L)	127 (65-225)	250 (120-320)		0.001
Neutrophil-to-lymphocyte ratio	4 (2.2.-8)	3 (2-5.3)		0.150
White blood cell count (103/L)	15.65 (11-21.6)	12.4 (8.9- 17.2)		0.004
Aspartate aminotransferase (U/L)	41 (26-90)	31 (24-53)		0.047
Alanine aminotransferase (U/L)	32 (18-66)	25 (14-47)		0.042
Urea (mg/dL)	31.5 (21-54_	21 (16.5-27.5)		0.001
Creatinine (mg/dL)	0.4 (0.3-0.6)	0.4 (0.3-0.5)		0.087
Ejection fraction	58 (48-62)	63 (60-66)		< 0.001
Fractional shortening	31 (26-33)	33.5 (33-35)		0.017
interleukin-6 (pg/mL) (n = 95)1	87.6 (19.2-320	29.9 (9.36-142)		0.08
D-dimer (mg/L) (n = 125)1	3.1 (1.57-5.1)	1.83 (0,88-3.29)		0.028
Procalcitonin (ng/mL) (n = 70)1	15.8 (2.2-44.5)	0.76 (0.25-5.62)		0.014
Troponin I (ng/mL) (n = 49)1	18.6 (0.01-141.8)	0.01		-
N-terminal pro-brain natriuretic peptide (pg/mL) (n = 49)1	4875 (559-16006)	26		-
Ferritin (ng/mL) (n = 166)1	575 (293-1335)	281 (254-576)		0.001
Coronavirus disease 2019 antibody titre	63.8 (24.8-95)	65.8 (23.5-102.4)		0.58
Hospital stay (days)	10 (7-13)	8 (7-11)		0.070
Prehospital illness (days)	5 (3-7)	5 (4-7)		0.333

¹Number of children who had undergone the test.

Table 2 Multivariate regression analysis

Condition	Parameter	Odds ratio	95%CI	Coefficient	SE	P value
Cardiovascular involvement	Breathlessness	3.91	1.25-12.21	1.36	0.58	0.019
	HFNC	8.50	1.06-68.38	2.14	1.06	0.044
Left ventricular dysfunction	Higher mean age	1.16	1.02-1.32	0.15	0.07	0.026
	Breathlessness	4.99	2.05-12.20	1.61	0.46	< 0.001
	Gallop	4.45	0.41-2.52	1.49	0.46	0.016
	Mitral regurgitation	3.61	1.53-8.53	1.28	0.44	0.004
	Invasive ventilation	4.01	1.28-12.58	1.39	0.58	0.017
Shock	Altered sensorium	4.96	2.23-11.02	1.60	0.41	< 0.001
	Headache	6.61	1.46-29.92	1.89	0.77	0.014
	Female gender	0.30	0.14-0.67	-1.19	0.40	0.003
	HFNC	7.03	2.04- 24.29	1.95	0.63	0.002
	Non-rebreathing mask	21.13	9.00-49.61	3.05	0.44	< 0.001
	Invasive ventilation	5.64	1.42-22.45	1.73	0.71	0.014
Coronary involvement	Anemia	3.09	1.79-5.34	1.13	4.07	< 0.001

HFNC: Hi-flow nasal cannula.

Table 3 Coronary arteries involved as per Z score in echocardiography at admission and follow-up, n (%)

Coronary dimension	Site	At admission	2 weeks	3 months	6 months	12 months
Normal	LMCA	190 (71.7)	201 (84.8)	215 (93.5)	216 (98.2)	218 (99.1)
	LAD	175 (67.1)	186 (78.5)	207 (91.6)	217 (98.2)	-
	RCA	207 (78.7)	209 (88.2)	218 (95.2)	217 (98.6)	218 (99.1)
Only dilatation	LMCA	25 (9.4)	2 (0.8)	3 (1.3)	1 (0.45)	-
	LAD	14 (5.4)	14 (5.9)	3 (1.33)	1 (0.45)	-
	RCA	10 (3.8)	10 (4.2)	3 (1.3)	1 (0.45)	-
Mild aneurysm	LMCA	46 (17.4)	31 (13.1)	10 (4.4)	2 (0.9)	1 (0.45)
	LAD	60 (22.9)	30 (12.7)	14 (6.2)	2 (0.9)	-
	RCA	41 (15.6)	14 (5.9)	6 (2.6)	1 (0.45)	1 (0.45)
Moderate aneurysm	LMCA	4 (1.51)	3 (1.3)	1 (0.43)	1 (0.45)	1 (0.45)
	LAD	11 (4.2)	5 (2.1)	2 (0.88)	1 (0.45)	-
	RCA	4 (1.5)	2 (0.84)	-	-	-
Giant aneurysm	LMCA	-	-	1 (0.43)	-	-
	LAD	1 (0.4)	2 (0.84)	-	-	-
	RCA	1 (0.4)	2 (0.84)	2 (0.87)	1 (0.45)	1 (0.45)

LMCA: Left main coronary artery; LAD: Left anterior descending artery; RCA: Right coronary artery.