A new retrospective research study has described factors that are likely to be associated with adverse outcomes of multisystemic inflammatory syndrome in children (MIS-C), a rare but severe hyperinflammatory condition that follows infection. SARS-CoV-2.
Children who go on to develop this newly recognized syndrome are present with a variety of clinical manifestations, but nearly 60% of them are admitted for intensive care. Mortality has occurred in approximately 2% of admitted patients.
“Understanding factors associated with more severe outcomes of patients with MIS-C could inform early prognosis and treatment decisions,” the study’s reviewers wrote.
A team from the U.S. Centers for Disease Control and Prevention (CDC), led by Joseph Abrams, PhD, evaluated all known cases reported by state and local health departments to determine the personal factors. – such as demographics, obesity, clinical features, and laboratory. results – may be associated with a course of severe syndrome.
Understanding the MIS-C Deficiency
Between March 11-October 10, 2020, 1080 patients experienced symptoms that met the CDC case definition for MIS-C.
Confirmed cases were “under 21 years of age, [had] fever, laboratory evidence of inflammation, [were] was admitted to hospital, [had] multisystem organ involvement (≥2), with no other plausible diagnosis, and either laboratory confirmation of SARS-CoV-2 infection by RT-PCR, serology, or antigen testing, or COVID-19 exposure known within 4 weeks before the onset of symptom. ”
The Abrams team used logistic regression models, adjusted for all previous features, to estimate odds ratios (ORs) between specific traits and adverse outcomes.
Thus, the researchers found that patients aged 6–12 years (OR, 1.9; 95% CI, 1.4–2.6) and 13–20 years (OR, 2.6; 95%, 1.8–3.8) were more likely to go into the ICU – against children aged 0-5 years.
This was similar for non-Hispanic Black patients (OR, 1.6; 95% CI, 1.0–2.4) compared with non-Hispanic white patients.
ICU admission was also higher among patients with shortness of breath (OR, 1.9; 95% CI, 1.2–2.9), abdominal pain (OR, 1.7; 95% CI, 1.2–2.7), as well as those with increased congestion of C- reactive protein, troponin, ferritin, D-dimer, brain natriuretic peptide (BNP), B-type N-terminal pro B-type, or interleukin-6, or reduced platelet or lymphocyte count.
“We found similar associations for reducing heart function, panic, and myocarditis,” the researchers said.
Coronary artery dysfunction has been more commonly reported in male patients (OR, 1.5; 95% CI, 1.1–2.1) than in female patients and patients with mucocutaneous lesions (OR, 2.2; 95% CI, 1.3–3.5 ) or conjunctival injection (OR, 2.3; 95% CI, 1.4–3.7).
Clinical resources
Abrams and colleagues noted that such findings could be helpful in identifying which children admitted to hospital are at higher risk for worse MIS-C-related outcomes. .
“However, regardless of earlier identification and, therefore, earlier treatment, of patients with a higher risk of adverse outcomes leads to better outcomes,” they said. “Further analysis by using temporal links between laboratory signals and results may help to clarify the predictability of the signals. ”
They also pointed out that their study did not account for possible explanatory factors for mortality – as well as the potential effects of other comorbidities on ICU admission.
Research is ongoing in this area to help clarify these links between clinical features in children and the depth and long-term effects of MIS-C.
The study, “Factors Associated with Adverse Outcomes in Multisystemic Inflammatory Syndrome in Children (MIS-C) in the USA: A Post-Study Study,” was published online in The Lancet: Child and Adolescent Health.