Clinical Characteristics and Outcomes in Children With Severe Multisystem Inflammatory Syndrome in Children in Malaysia: A Nationwide Cohort Study

Hing Cheong Kok1; Dinesh Nair1 ,; Ee Vien Low2; Mohd Nizam Mat Bah3; David Chun-Ern Ng4; Anis Siham Zainal Abidin5,6; Fu Lung Khiu7; Huong Nai Law7; Heng Kiat Pung6; Ke Juin Wong1; Kwee Ching See8; Putri Nor Baiti Mohamad Radzi8; Kwai Cheng Chan9; Lina Lim10; Deenish Muniandy11; Nik Khairulddin Nik Yusoff12; Lydia Toon Muhammad Nasrun Toon3; Emieliyuza Yusnita Alias3; Pheik Sian Choong13; Muhammad Syarhan Nor Hadid14; Haema Shunmugarajoo15; Prakash Rao Rama Rao16; Siew Moy Fong1

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Clinical Characteristics and Outcomes in Children With Severe Multisystem Inflammatory Syndrome in Children in Malaysia: A Nationwide Cohort Study

Author: Hing Cheong Kok1 ^{1
,

2} ; Dinesh Nair1 , ^{1
,

2} ; Ee Vien Low2 ³ ; Mohd Nizam Mat Bah3 ⁴ ; David Chun-Ern Ng4 ^{5
,

6} ; Anis Siham Zainal Abidin5,6 ⁷ ; Fu Lung Khiu7 ⁸ ; Huong Nai Law7 ⁸ ; Heng Kiat Pung6 ⁹ ; Ke Juin Wong1 ^{1
,

2} ; Kwee Ching See8 ¹⁰ ; Putri Nor Baiti Mohamad Radzi8 ¹⁰ ; Kwai Cheng Chan9 ¹¹ ; Lina Lim10 ¹² ; Deenish Muniandy11 ¹³ ; Nik Khairulddin Nik Yusoff12 ¹⁴ ; Lydia Toon Muhammad Nasrun Toon3 ⁴ ; Emieliyuza Yusnita Alias3 ⁴ ; Pheik Sian Choong13 ¹⁵ ; Muhammad Syarhan Nor Hadid14 ¹⁶ ; Haema Shunmugarajoo15 ¹⁷ ; Prakash Rao Rama Rao16 ¹⁸ ; Siew Moy Fong1 ^{1
,

2}
Author Information

1. Department of Paediatrics, Sabah Women and Children&rsquo
2. s Hospital, Ministry of Health Malaysia, 88996 Kota Kinabalu, Sabah, Malaysia
3. Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, 40170 Setia Alam, Selangor, Malaysia.
4. Department of Paediatrics, Sultanah Aminah Hospital, Ministry of Health Malaysia, 80100 Johor Bahru, Joor, Malaysia.
5. Department of Paediatrics, Tuanku Ja&rsquo
6. afar Hospital, Ministry of Health Malaysia, 70300 Seremban, Negeri Sembilan, Malaysia
7. Department of Paediatrics, Faculty of Medicine, MARA University of Technology, 40450 Shah Alam, Selangor, Malaysia. and Department of Paediatrics, Selayang Hospital, Ministry of Health Malaysia, 68100 Selayang, Selangor, Malaysia
8. Department of Paediatrics, Sarawak General Hospital, Ministry of Health Malaysia, 93586 Kuching, Sarawak, Malaysia.
9. Department of Paediatrics, Selayang Hospital, Ministry of Health Malaysia, 68100 Selayang, Selangor, Malaysia.
10. Department of Paediatrics, Sungai Buloh Hospital, Ministry of Health Malaysia, 47000 Sungai Buloh, Selangor, Malaysia.
11. Department of Paediatrics, Penang General Hospital, Ministry of Health Malaysia, 10450 Georgetown, Pulau Pinang, Malaysia.
12. Department of Paediatrics, Malacca General Hospital, Ministry of Health Malaysia, 75400 Malacca, Malaysia
13. Department of Paediatrics, Tawau Hospital, Ministry of Health Malaysia, 91000 Tawau, Sabah, Malaysia.
14. Department of Paediatrics, Raja Perempuan Zainab II Hospital, Ministry of Health Malaysia, 15586 Kota Bharu, Malaysia
15. Department of Paediatrics, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, 05460 Alor Setar, Kedah, Malaysia.
16. Department of Paediatrics, Sultanah Nora Ismail Hospital, Ministry of Health Malaysia, 83000 Batu Pahat, Johor, Malaysia
17. Department of Paediatrics, Raja Permaisuri Bainun Hospital, Ministry of Health Malaysia, 30450 Ipoh, Perak, Malaysia.
18. Department of Paediatrics, Keningau Hospital, Ministry of Health Malaysia, 89007 Keningau, Sabah, Malaysia.
Publication Type:Journal Article
Keywords: Coronary artery aneurysm; Outcomes; Mortality; Multisystem inflammatory syndrome in children (MIS-C); SARS-CoV-2
From:Malaysian Journal of Medicine and Health Sciences 2025;21(No. 1):18-26
CountryMalaysia
Language:English
Abstract: Introduction: Early identification of patients at risk for severe multisystem inflammatory syndrome in children (MIS-C) is essential for favourable clinical outcomes. This study aims to identify the clinical characteristics, factors and outcomes associated with severe MIS-C. Materials and methods: In this retrospective cohort study involving 14 major hospitals in Malaysia, children <15 years who met the United States Centres for Disease Control and Prevention case definition for MIS-C were included. Severe MIS-C was defined as children who required inotropic support, ventilatory support (invasive or non-invasive ventilation), or left ventricular ejection fraction of <55%. The factors investigated for severe MIS-C were demographic characteristics, the presence of comorbidities, clinical characteristics, and laboratory measures. Multivariable logistic regression was used to compute the adjusted odds ratio (aORs) of factors associated with severe MIS-C. Results: Among the 155 patients, 91 (58.7%) presented with severe MIS-C. Severe MIS-C was more likely in patients aged ≥5 years old (aOR 2.13, 95% confidence interval [CI] 1.08-4.21), with dehydration (aOR 3.80, 95% CI 1.53-9.45), lethargy (aOR 2.02, 95% CI 0.97-4.18), tachycardia (aOR 8.33, 95% CI 3.27-21.22), albumin <30g/L (aOR 3.36, 95% CI 1.58-7.13), creatine kinase >200U/L (aOR 3.68, 95% CI 1.57-8.64), D-dimer >3.0µg/mL (aOR 2.11, 95% CI 1.08-4.13), ferritin >500ng/mL (aOR 3.77, 95% CI 1.88-7.55), prothrombin time >12.7 seconds (aOR 3.22, 95% CI 1.61-6.43), and urea >6mmol/L (aOR 5.09, 95% CI 2.04-12.71). Conclusion: Identification of these associated factors of severity in MIS-C could aid in early recognition and prompt escalation of care, leading to better outcomes.
Full text:2025071810404943016202502121220054_MJMHS_0717.pdf