Gastrointestinal Manifestations and Disease Severity in Children with Multisystem Inflammatory Syndrome: A Retrospective Cohort Study
Ana Maghradze, Nani Kavlashvili and Ivane Chkhaidze
ABSTRACT
Background: Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious hyperinflammatory complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Gastrointestinal manifestations are common, but their relationship with disease severity remains uncertain.
Objective: To evaluate the association between gastrointestinal manifestations and MIS-C severity and to characterize clinical and laboratory features associated with severe disease.
Methods: This retrospective cohort study included 122 consecutive patients aged 0–17 years who were diagnosed with MIS-C at a tertiary pediatric referral
center in Tbilisi, Georgia, between 2020 and 2023. Patients were classified as having moderate (n=82) or severe (n=40) disease. Categorical variables were compared using Pearson’s chi-square test, and continuous variables were analyzed using the independent-samples t test or Mann–Whitney U test, as Appropriate. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for clinical manifestations.
Results: Gastrointestinal manifestations were present in 84 patients (68.9%) and were more frequent in moderate than severe MIS-C (76.8% vs 52.5%; p=0.006). Gastrointestinal involvement was associated with lower crude odds of severe disease (OR 0.33, 95% CI 0.15–0.75). Severe MIS-C was associated with neurocognitive manifestations (OR 5.10, 95% CI 1.43–18.16), respiratory involvement (OR 6.33, 95% CI 2.51–15.97), shock (OR 32.73, 95% CI 7.05151.93), and Kawasaki-like manifestations (OR 12.68, 95% CI 3.36–47.90). Severe disease was also associated with higher body temperature, erythrocyte sedimentation rate, neutrophilia, and C-reactive protein. Thrombocytopenia and D-dimer did not differ significantly between groups.
Conclusions: Gastrointestinal manifestations were common but occurred more frequently in moderate MIS-C, suggesting that they may represent an early or clinically prominent inflammatory phenotype rather than an isolated marker of advanced disease. Severe MIS-C was characterized primarily by hemodynamic instability, respiratory and neurocognitive involvement, Kawasaki-like features, and greater inflammatory activity. Prospective multicenter studies are needed to determine the independent prognostic value of specific gastrointestinal manifestations.
