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\begin{document}

\title{Lymphocyte subsets in 32 patients with multisystem inflammatory syndrome
in children (MIS-C)}



\author[1]{Magdalena Okarska-Napierała}%
\author[1]{Joanna Mańdziuk}%
\author[1]{Wojciech Feleszko}%
\author[1]{Anna Stelmaszczyk-Emmel}%
\author[1]{Mariusz Panczyk}%
\author[1]{Urszula Demkow}%
\author[1]{Ernest Kuchar}%
\affil[1]{Medical University of Warsaw}%


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  \date{May 21, 2024}


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\begin{abstract}
BACKGROUND: Lymphopenia is a hallmark of multisystem inflammatory
syndrome in children (MIS-C). We aimed to characterize lymphocyte
subsets' shifts and their correlations with other severity markers of
MIS-C. METHODS: In this prospective cross-sectional study, we performed
peripheral lymphocyte phenotyping in 32 patients with MIS-C. We analyzed
lymphocyte subsets at three time-points of the disease: the acute (A),
convalescent (B), and recovery (C) phases. Based on age-normalized
lymphocyte counts, we distinguished two groups of patients: ``the mild''
and ``the severe''. In addition, we examined differences between these
groups regarding other severity markers. RESULTS: In phase A, 84\% of
children had lymphopenia. Decreased absolute counts of CD3, CD4, and CD8
cells were observed in, respectively, 88\%, 72\%, and 84\% of patients.
The natural killer cells were decreased in 63\% and CD19 in 59\% of
children. ``The severe'' group had significantly higher procalcitonin
and troponin I levels and lower platelets and albumin. Moreover, ``the
severe'' group had hypotension more frequently (73\% vs. 20\%, p=0.008).
In phase B, all lymphocyte counts increased, and 32\% of children had
lymphocytosis. The increase of CD3, CD4, and CD8 counts correlated with
some laboratory severity markers (hemoglobin, procalcitonin, D-dimer,
lactate dehydrogenase, N-terminal prohormone of brain natriuretic
peptide, albumin), but not with steroid use. In phase C, most children
had normal lymphocyte counts. CONCLUSIONS: Substantial shifts in
lymphocyte counts during MIS-C apply most to T lymphocytes and correlate
with the disease severity markers, particularly hypotension prevalence.
A proportion of children with MIS-C develops transient lymphocytosis
during convalescence.%
\end{abstract}%



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