الفهرس 
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Abstract
M
SUMMARY
ultisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection is uncommon, but it is life-threatening, frequently presenting as rapid-onset severe organ failure. It is thought to be driven by a post-viral dysregulated immune response, although the underlying pathophysiological processes are still poorly understood. The clinical features of MIS-C have led to the assumption that the inflammation is exceptionally high, so-called cytokine storm; thus, empirical immunomodulation is the current therapy.
However, there is no clear definition for cytokine storm. In theory, it refers to a harmful level of cytokines. However, as pointed out by some authors’ the term is misleading because it falsely gives some impression to be related to a different entity, the cytokine release syndrome (CRS). CRS is a severe systemic inflammatory response caused by cytokines released by infused Chimeric antigen receptor (CAR)-modified T cells (CAR-Ts), where IL-6 is one of the main drivers.
Interleukin-6 (IL-6) is a pleiotropic cytokine with a pivotal role in the inflammatory and anti-inflammatory pathways. It has been previously studied in many conditions characterized by local or systemic insults, like bacterial and viral sepsis, and autoimmune diseases, like juvenile rheumatoid arthritis (JRA).
The aim of the study was to evaluate the correlation between the level of IL-1 and cases of COVID-14 and MIS-C progression and outcomes.
The results of our present study can be summarized as follows:
In our study, regarding lymphocytes, it showed lymphopenia 11(45.83%) and lymphocytosis 1 (4.17) in COVID group.
In our study, regarding platelets count it showed thrombocytopenia 4(16.67%).
Regarding CRP, it showed increase level in 20 (83.33%).
There were no statistically significant difference between the median of CRP 1 in discharged and died groups.
Regarding ferritin, it showed increase level in 12(50%).
Regarding CK-Total it showed increase level in 12(50%) IN COVID group.
Regarding CK-MP it showed increase level in 13(54.17%) IN COVID group.
Regarding LDH it showed increase level in 21(87.5%) IN COVID group. There were no statistically significant difference between the median of LDH in discharged and died groups.
Regarding albumin, 20(83.33%) had hypoalbuminemia IN COVID group. There were statistically significant difference between the median of albumin in discharged and died groups.
The results showed that in moderate cases median of IL-6 27.6(12.65-245.7), comorbidities in 4(21.05%) and they were died
In severe cases median of IL-6 318.8(318.8-467), comorbidities in 3(60%) and 2(40%) were died
Also, There were statistically significant difference between Discharged group and died group regarding IL-6 in COVID-19 group.
Regarding radiological findings, Pneumonic patch in CXR 24(100%). Pneumonic patch in CT CHEST 9 (37.5%). Ground glass appearance in 15(62.5%).
Regarding D –dimer it showed increase level in 22(91.67%) in COVID-19 group. There were no statistically significant difference between the median of D –dimer in discharged and died groups.
Regarding troponine it showed increase level in 1 (4.17%) in COVID-19 group. There were no statistically significant difference between the median of troponine in discharged and died groups.
In our results, we have 18(62.07%) male and 11(37.93%) female. With median of age (9 (6 - 12)).
Our results showed that the median of IL-6 in MIS-C group was (72.69 (20.22 - 140.5)).
Also, There were statistically significant difference between Discharged group and died group regarding IL-6.
The current study showed that the median of PICU stay was 6.42+_2.57 days in MIS-C group. All of our patients 100% were admitted to our PICU, 1(3.45%) admitted due to respiratory distress. 1(3.45%) were admitted due to respiratory distress and shock. 27(93.1%) were admitted due to shock.
Regarding CRP, it showed increased levels in 27(93.1%) of our patients with P-value 0.392 non-significant.
Regarding ferritin, it showed increased levels in 24(82.76%) of our patients with P-value 0.011 significant.
Regarding D-dimer it showed increased levels in 23(79.31%) of our patients with P-value 0.269 non-significant in MIS-C group.
Regarding AST it showed 40 (25 - 75) of our patients with P-value 0.042 in MIS-C group.
Regarding Troponin, it showed increased levels in 24 (82.76%) of our patients with P-value <0.001 significant in MIS-C group.
Regarding Lymphocytes, it showed lymphopenia in 11(37.93%) of our patient. Regarding platelets counts it showed thrombocytopenia 16(55.17%) of our patients.
Regarding CK-Total it showed increased levels in 8(27.59%) of our patients with P-value 0.094 non-significant. Regarding CK-MB it showed increased levels in 15(51.72%) of our patients with P-value 0.859 non-significant. Regarding LDH it showed increased levels in 25(86.21%) of our patients with P-value 0.28 non-significant.
Regarding AST it showed 40 (25 - 75) with P-value 0.042 significant. Regarding ALT it showed 35 (15 - 46) with P-value 0.012significant in MIS-C group.
Regarding cardiac affection in general we had 22(75.9%) on admission and 20(69%) on discharge. Regarding presence of LVD, on presentation 18(62.1%) patients had LVD and on discharge 12(41.4%) patients had LVD. Regarding the presence of pericardial effusion 4(13.8%) patients had pericardial effusion and on discharge 3(10.3%). Regarding coronary affection 14(48.3%) on admission and 5(17.2%) on discharge.
The median of length stay was 6.42+_2.57 days. Regarding fate, 2(6.9%) of our patients were died. Regarding comorbidities,8(27.85%) of our patients had associated comorbidities ,2(25%) of them were died in MIS-C.
CONCLUSION
Bases on the results of the current study it can be concluded that:
IL-6 plasma concentration was increased in severe MIS-C patients. IL-6 level could effectively recognizeCOVID-19 severity.
Most characteristics of the present MIS-C patients were similar to that of other studies.
These outcomes lead us to question the function of IL-6 in the pathobiology of MIS-C, its diagnosis, clinical results, and, more importantly, the off-name utilization of IL-6 inhibitors for these cases.
RECOMMENDATION
As many aspects of MIS-C remain undetected, collective and global efforts are required for fast-tracked patient-centered research, including the situation of immune-memory and immune system serology to predict long term results.