comparison of clinical features and outcomes of shocks in multisystem inflammatory syndrome in children associated with covid-19 (mis-c), septic shock, and cardiogenic shock

Background: multisystem inflammatory syndrome in children associated with covid-19 (mis-c) is an inflammatory disorder that shares similarities with kawasaki disease and toxic shock syndrome. the majority of mis-c patients exhibit cardiovascular abnormalities, with cardiogenic and vasodilatory shock occurring in 60% of cases. objectives: to determine the differences between mis-c shock, septic shock, and cardiogenic shock. methods: this retrospective observational study was conducted between january 2021 and december 2022. the study included children aged between 1 month and 15 years with mis-c shock, septic shock, and cardiogenic shock. patients’ medical records were reviewed, including clinical presentations, laboratory results, treatments, and outcomes. results: the study included 60 patients: 13 (22%) with mis-c shock, 33 (55%) with septic shock, and 14 (23%) with cardiogenic shock. compared to septic shock and cardiogenic shock, mis-c patients were more likely to present with a rash (p < 0.001). multisystem inflammatory syndrome in children shock patients had significantly lower lymphocyte counts (p = 0.001). chest radiograph and echocardiography abnormalities were more common in mis-c shock and cardiogenic shock patients than in septic shock patients (p = 0.004). uscom results indicated that mis-c shock patients displayed a combination of a decreased inotropic index and systemic vascular resistance index. conclusions: the most distinct clinical feature of mis-c shock is a cutaneous manifestation combined with higher levels of inflammation and a decreased lymphocyte count, caused by vasodilation and myocardial dysfunction.