الفهرس 
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Abstract
M
ulti system inflammatory syndrome in children (MIS-C) represents a rare but severe complication of severe acute respiratory syndrome coronavirus infection affecting children.
Oxidative stress is a phenomenon caused by an imbalance between production and accumulation of oxygen reactive species (ROS) in cells and tissues and the ability of a biological system to detoxify these reactive products
The peroxiredoxins (PRDX) are a recently identified class of antioxidant enzymes and are more associated with cellular signaling mechanisms during oxidative stress. They are the enzymes that efficiently scavenge hydrogen peroxide and organic peroxides, thus protecting cells against reactive oxygen species (ROS) accumulation and playing a role in redox dependent signaling pathways.
We measured serum Peroxiredoxin 4 (PRDX 4) level in children with acute covid 19 infection and Multisystem inflammatory syndrome in children related to covid 19 as a prognostic value of oxidative stress. also assessed its relation to clinical, laboratory and radiological variables
This cross sectional study was carried out in Pediatric Hospital, Ain Shams University and included patients with MIS-C (n=29) with median age (66) months, They consisted of 19 (65.5%) males and 10 (34.5%) females and patients with COVID-19 (n=28) with median age (45) months, They consisted of 16 (57.1%) males and 12 (42.9%) females both patients groups were compared to (n=25) age and sex matched healthy controls.
All the included patients were subjected to: (i) detailed medical history with special emphasis on age, fever and respiratory, GIT and neurological manifestations; (ii) thorough clinical examination laying stress on anthropometric measures, vital signs, and eye, chest and cardiac examination; (iii) chest x-ray, CT-chest, ECG and echocardiography; (iv) Laboratory investigations including Covid-19 PCR, Covid-19 antibodies CBC, blood gases, CRP, D-dimer, LDH, serum ferritin, CK total and CK-MB, Troponin I, liver and kidney function tests as well as measurement of Peroxiredoxin 4 levels by enzyme linked immunosorbent assay (ELISA).
Upon comparison of clinical data between patients with MIS-C and COVID-19 patients revealed that patients with MIS-C had higher heart rate and lower respiratory rate.
Moreover, oxygen saturation was significantly lower among patients with COVID-19 compared with MIS-C patients. The most common cause of PICU admission in MIS-C was shock with carditis being found in 19 (65.5%) patients. The most common disease manifestation was fever and conjunctivitis followed by rash and hypotension. It was found that the use of vasoactive support and cardiac support was significantly higher in patients with MIS-C while the use of respiratory support was higher in COVID-19 patients.
As regards laboratory data, PCO2 was significantly higher in patients with COVID-19 while patients with MIS-C had significantly higher WBCs and lower platelet count compared with COVID-19 patients. Patients with MIS-C had higher level of serum creatinine, ferritin, CRP and D-dimer compared with COVID-19 patients. Abnormal chest X-ray was found in (57.2%) of COVID-19 patients and it was significantly higher compared to patients with MIS-C (27.6%).
Echocardiography showed carditis in 17 (58.6%) of patients with MIS-C.
Peroxiredoxin 4 levels were significantly higher in covid 19 patients compared to MIS-C patients and healthy controls.
In MIS-C patients, Peroxiredoxin 4 were significantly higher with Extermities changes and elevated ESR level.
ROC curve analysis showed that Peroxiredoxin 4 cut- off (<8.40ng/ml) could detect MIS-C patients with sensitivity 100% and specificity 96.6% and cut-off (>8.40ng/ml) could detect Covid 19 patients with sensitivity 100% and specificity 96.6%.
Also cut-off (36.6ng/ml) could differentiate between MIS-C and Covid19 patients with sensitivity 79.3% and specificity 53.6%.