OBJECTIVE: To differentiate severe/critical coronavirus disease 2019 (COVID-19) 
infection from multisystem inflammatory syndrome in children (MIS-C).
METHODS: Single-center chart review comparing characteristics of children with 
MIS-C and 'severe/critical' COVID-19 infection. Multivariate logistic regression 
was performed to create predictive models for predicting MIS-C.
RESULTS: Of 68 patients, 28 (41.2%) had MIS-C while 40 (58.8%) had 
severe/critical COVID-19 infection. MIS-C patients had a higher prevalence of 
fever, mucocutaneous, cardiac and gastrointestinal involvement and a lower 
prevalence of respiratory symptoms (P<0.05). Significantly lower hemoglobin, 
platelet count, serum electrolytes, and significantly elevated inflammatory and 
coagulation markers were observed in MIS-C cohort. Upon multivariate logistic 
regression, the best model included C-reactive protein (CRP), platelet count, 
gastrointestinal and mucocutaneus involvement and absence of respiratory 
involvement (performance of 0.94). CRP>40 mg/L with either platelet count 
<150x109 or mucocutaneous involvement had specificity of 97.5% to diagnose 
MIS-C.
CONCLUSION: Elevated CRP, thrombocytopenia and mucocutaneous involvement at 
presentation are helpful in differentiating MIS-C from severe COVID-19.