Similarities and differences between MIS-C and KD: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 36471327 · doi:10.1186/s12969-022-00771-x
What was done
A systematic review and meta-analysis of studies published prior to February 28, 2022, was conducted using PubMed, EMBASE, and other databases. The authors compared demographic, clinical, laboratory, cardiac complication, and therapeutic profiles between patients with multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) across 14 studies (n = 2,928).
What was found
MIS-C patients were older than KD patients, with no difference in sex ratio. MIS-C had higher frequencies of respiratory symptoms, gastrointestinal symptoms, and shock, but lower rates of conjunctivitis. Laboratory analyses showed lower lymphocyte counts, platelet counts, ESR, ALT, and albumin in MIS-C, alongside higher AST, NT-pro-BNP, troponin, CRP, D-dimer, fibrinogen, ferritin, and creatinine. Cardiac complications including left ventricular dysfunction, valvular regurgitation, pericardial effusion, myocarditis, and pericarditis were more frequent in MIS-C. Overall coronary artery lesion incidence was significantly lower in MIS-C (OR 0.52, 95% CI 0.29 to 0.93, p = 0.03), though rates were similar during the acute period. Glucocorticoid use was higher and intravenous immunoglobulin use was lower in MIS-C. Numerical effect sizes and confidence intervals were not provided in the abstract for the other outcomes.
Why it matters
This synthesis provides pooled evidence clarifying key clinical and laboratory differences between MIS-C and KD, assisting clinicians in distinguishing between the two overlapping pediatric hyperinflammatory conditions.
Limits
The abstract reports numerical effect sizes and confidence intervals for only one outcome (coronary artery lesions), omitting quantitative effect estimates and heterogeneity measures for other comparisons. The included evidence consists of observational studies susceptible to selection bias, residual confounding, and varying case definitions.
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