1.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
Malaysian Journal of Medicine and Health Sciences 2025;21(No. 1):18-26
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.
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