Original scientific paper
https://doi.org/10.37797/ig.43.3.1
From Presentation to Intensive Care: Predictors of PICU Admission in Croatian Children with MIS-C
Silva Šiftar
; Pediatric Infectious Disease Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Zagreb, Croatia
*
Dominik Ljubas
; Pediatric Infectious Disease Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Zagreb, Croatia
Hrvoje Kniewald
; Department of Pediatric Cardiology, Sisters of Charity Hospital, Zagreb, Croatia
CroMIS-C Study Group
Lorna Stemberger Marić
; Pediatric Infectious Disease Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
* Corresponding author.
Abstract
Aim: Multisystem Inflammatory Syndrome in Children (MIS-C) is a hyperinflammatory condition associated with COVID-19 characterized by immune dysregulation that may lead to organ dysfunction and shock, with cardiac involvement being the most important manifestation. Patients often require PICU admission (43-88%) but usually with favorable outcomes. Elevated inflammatory markers, cardiac involvement and shock have been identified as major predictors of PICU admission.
Methods: This retrospective multicenter study aimed to identify risk factors for PICU admission among MIS-C patients treated from 2020 to 2024 in Croatia. Demographic, clinical, laboratory and echocardiographic data were compared between PICU and non-PICU patients.
Results: We analyzed 136 patient records treated for MIS-C with a 52.2% PICU admission rate. Elevated CRP levels along with myocarditis, congestive heart failure, mitral regurgitation and pleural effusion were significantly more common in the PICU group. Multivariate analysis identified CRP (per 10 mg/L increase, aOR 1.10, 95% CI: 1.03–1.18, p = 0.002), myocarditis (aOR 3.04, 95% CI: 1.10–9.16, p = 0.038) and mitral regurgitation (aOR 2.87, 95% CI: 1.24–6.93, p = 0.016) as factors associated with PICU admission.
Conclusion: Considering the potential severity of the disease, prompt recognition of risk factors and early echocardiographic evaluation are crucial for early assessment of cardiac involvement and the need for intensive care. In this context, our findings indicate that mitral regurgitation, myocarditis, and elevated CRP levels are important indicators of increased risk, as they were associated with a higher likelihood of PICU admission.
Keywords
MIS-C associated with COVID-19; Pediatric ICU; myocarditis; mitral regurgitation
Hrčak ID:
352442
URI
Publication date:
19.10.2026.
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