tetano
Editor, Senior Moderator
JAMA
. 2021 Feb 24.
doi: 10.1001/jama.2021.2091. Online ahead of print.
Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19
Leora R Feldstein[SUP] 1 2 [/SUP], Mark W Tenforde[SUP] 1 [/SUP], Kevin G Friedman[SUP] 3 [/SUP], Margaret Newhams[SUP] 4 [/SUP], Erica Billig Rose[SUP] 1 2 [/SUP], Heda Dapul[SUP] 5 [/SUP], Vijaya L Soma[SUP] 6 [/SUP], Aline B Maddux[SUP] 7 [/SUP], Peter M Mourani[SUP] 7 [/SUP], Cindy Bowens[SUP] 8 [/SUP], Mia Maamari[SUP] 8 [/SUP], Mark W Hall[SUP] 9 [/SUP], Becky J Riggs[SUP] 10 [/SUP], John S Giuliano Jr[SUP] 11 [/SUP], Aalok R Singh[SUP] 12 [/SUP], Simon Li[SUP] 13 [/SUP], Michele Kong[SUP] 14 [/SUP], Jennifer E Schuster[SUP] 15 [/SUP], Gwenn E McLaughlin[SUP] 16 [/SUP], Stephanie P Schwartz[SUP] 17 [/SUP], Tracie C Walker[SUP] 17 [/SUP], Laura L Loftis[SUP] 18 [/SUP], Charlotte V Hobbs[SUP] 19 [/SUP], Natasha B Halasa[SUP] 20 [/SUP], Sule Doymaz[SUP] 21 [/SUP], Christopher J Babbitt[SUP] 22 [/SUP], Janet R Hume[SUP] 23 [/SUP], Shira J Gertz[SUP] 24 [/SUP], Katherine Irby[SUP] 25 [/SUP], Katharine N Clouser[SUP] 26 [/SUP], Natalie Z Cvijanovich[SUP] 27 [/SUP], Tamara T Bradford[SUP] 28 [/SUP], Lincoln S Smith[SUP] 29 [/SUP], Sabrina M Heidemann[SUP] 30 [/SUP], Sheemon P Zackai[SUP] 31 [/SUP], Kari Wellnitz[SUP] 32 [/SUP], Ryan A Nofziger[SUP] 33 [/SUP], Steven M Horwitz[SUP] 34 [/SUP], Ryan W Carroll[SUP] 35 [/SUP], Courtney M Rowan[SUP] 36 [/SUP], Keiko M Tarquinio[SUP] 37 [/SUP], Elizabeth H Mack[SUP] 38 [/SUP], Julie C Fitzgerald[SUP] 39 [/SUP], Bria M Coates[SUP] 40 [/SUP], Ashley M Jackson[SUP] 1 [/SUP], Cameron C Young[SUP] 4 [/SUP], Mary Beth F Son[SUP] 41 [/SUP], Manish M Patel[SUP] 1 2 [/SUP], Jane W Newburger[SUP] 3 [/SUP], Adrienne G Randolph[SUP] 4 42 [/SUP], Overcoming COVID-19 Investigators
Affiliations
Abstract
Importance: Refinement of criteria for multisystem inflammatory syndrome in children (MIS-C) may inform efforts to improve health outcomes.
Objective: To compare clinical characteristics and outcomes of children and adolescents with MIS-C vs those with severe coronavirus disease 2019 (COVID-19).
Setting, design, and participants: Case series of 1116 patients aged younger than 21 years hospitalized between March 15 and October 31, 2020, at 66 US hospitals in 31 states. Final date of follow-up was January 5, 2021. Patients with MIS-C had fever, inflammation, multisystem involvement, and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) or antibody test results or recent exposure with no alternate diagnosis. Patients with COVID-19 had positive RT-PCR test results and severe organ system involvement.
Exposure: SARS-CoV-2.
Main outcomes and measures: Presenting symptoms, organ system complications, laboratory biomarkers, interventions, and clinical outcomes. Multivariable regression was used to compute adjusted risk ratios (aRRs) of factors associated with MIS-C vs COVID-19.
Results: Of 1116 patients (median age, 9.7 years; 45% female), 539 (48%) were diagnosed with MIS-C and 577 (52%) with COVID-19. Compared with patients with COVID-19, patients with MIS-C were more likely to be 6 to 12 years old (40.8% vs 19.4%; absolute risk difference [RD], 21.4% [95% CI, 16.1%-26.7%]; aRR, 1.51 [95% CI, 1.33-1.72] vs 0-5 years) and non-Hispanic Black (32.3% vs 21.5%; RD, 10.8% [95% CI, 5.6%-16.0%]; aRR, 1.43 [95% CI, 1.17-1.76] vs White). Compared with patients with COVID-19, patients with MIS-C were more likely to have cardiorespiratory involvement (56.0% vs 8.8%; RD, 47.2% [95% CI, 42.4%-52.0%]; aRR, 2.99 [95% CI, 2.55-3.50] vs respiratory involvement), cardiovascular without respiratory involvement (10.6% vs 2.9%; RD, 7.7% [95% CI, 4.7%-10.6%]; aRR, 2.49 [95% CI, 2.05-3.02] vs respiratory involvement), and mucocutaneous without cardiorespiratory involvement (7.1% vs 2.3%; RD, 4.8% [95% CI, 2.3%-7.3%]; aRR, 2.29 [95% CI, 1.84-2.85] vs respiratory involvement). Patients with MIS-C had higher neutrophil to lymphocyte ratio (median, 6.4 vs 2.7, P < .001), higher C-reactive protein level (median, 152 mg/L vs 33 mg/L; P < .001), and lower platelet count (<150 ?103 cells/μL [212/523 {41%} vs 84/486 {17%}, P < .001]). A total of 398 patients (73.8%) with MIS-C and 253 (43.8%) with COVID-19 were admitted to the intensive care unit, and 10 (1.9%) with MIS-C and 8 (1.4%) with COVID-19 died during hospitalization. Among patients with MIS-C with reduced left ventricular systolic function (172/503, 34.2%) and coronary artery aneurysm (57/424, 13.4%), an estimated 91.0% (95% CI, 86.0%-94.7%) and 79.1% (95% CI, 67.1%-89.1%), respectively, normalized within 30 days.
Conclusions and relevance: This case series of patients with MIS-C and with COVID-19 identified patterns of clinical presentation and organ system involvement. These patterns may help differentiate between MIS-C and COVID-19.
. 2021 Feb 24.
doi: 10.1001/jama.2021.2091. Online ahead of print.
Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19
Leora R Feldstein[SUP] 1 2 [/SUP], Mark W Tenforde[SUP] 1 [/SUP], Kevin G Friedman[SUP] 3 [/SUP], Margaret Newhams[SUP] 4 [/SUP], Erica Billig Rose[SUP] 1 2 [/SUP], Heda Dapul[SUP] 5 [/SUP], Vijaya L Soma[SUP] 6 [/SUP], Aline B Maddux[SUP] 7 [/SUP], Peter M Mourani[SUP] 7 [/SUP], Cindy Bowens[SUP] 8 [/SUP], Mia Maamari[SUP] 8 [/SUP], Mark W Hall[SUP] 9 [/SUP], Becky J Riggs[SUP] 10 [/SUP], John S Giuliano Jr[SUP] 11 [/SUP], Aalok R Singh[SUP] 12 [/SUP], Simon Li[SUP] 13 [/SUP], Michele Kong[SUP] 14 [/SUP], Jennifer E Schuster[SUP] 15 [/SUP], Gwenn E McLaughlin[SUP] 16 [/SUP], Stephanie P Schwartz[SUP] 17 [/SUP], Tracie C Walker[SUP] 17 [/SUP], Laura L Loftis[SUP] 18 [/SUP], Charlotte V Hobbs[SUP] 19 [/SUP], Natasha B Halasa[SUP] 20 [/SUP], Sule Doymaz[SUP] 21 [/SUP], Christopher J Babbitt[SUP] 22 [/SUP], Janet R Hume[SUP] 23 [/SUP], Shira J Gertz[SUP] 24 [/SUP], Katherine Irby[SUP] 25 [/SUP], Katharine N Clouser[SUP] 26 [/SUP], Natalie Z Cvijanovich[SUP] 27 [/SUP], Tamara T Bradford[SUP] 28 [/SUP], Lincoln S Smith[SUP] 29 [/SUP], Sabrina M Heidemann[SUP] 30 [/SUP], Sheemon P Zackai[SUP] 31 [/SUP], Kari Wellnitz[SUP] 32 [/SUP], Ryan A Nofziger[SUP] 33 [/SUP], Steven M Horwitz[SUP] 34 [/SUP], Ryan W Carroll[SUP] 35 [/SUP], Courtney M Rowan[SUP] 36 [/SUP], Keiko M Tarquinio[SUP] 37 [/SUP], Elizabeth H Mack[SUP] 38 [/SUP], Julie C Fitzgerald[SUP] 39 [/SUP], Bria M Coates[SUP] 40 [/SUP], Ashley M Jackson[SUP] 1 [/SUP], Cameron C Young[SUP] 4 [/SUP], Mary Beth F Son[SUP] 41 [/SUP], Manish M Patel[SUP] 1 2 [/SUP], Jane W Newburger[SUP] 3 [/SUP], Adrienne G Randolph[SUP] 4 42 [/SUP], Overcoming COVID-19 Investigators
Affiliations
- PMID: 33625505
- DOI: 10.1001/jama.2021.2091
Abstract
Importance: Refinement of criteria for multisystem inflammatory syndrome in children (MIS-C) may inform efforts to improve health outcomes.
Objective: To compare clinical characteristics and outcomes of children and adolescents with MIS-C vs those with severe coronavirus disease 2019 (COVID-19).
Setting, design, and participants: Case series of 1116 patients aged younger than 21 years hospitalized between March 15 and October 31, 2020, at 66 US hospitals in 31 states. Final date of follow-up was January 5, 2021. Patients with MIS-C had fever, inflammation, multisystem involvement, and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) or antibody test results or recent exposure with no alternate diagnosis. Patients with COVID-19 had positive RT-PCR test results and severe organ system involvement.
Exposure: SARS-CoV-2.
Main outcomes and measures: Presenting symptoms, organ system complications, laboratory biomarkers, interventions, and clinical outcomes. Multivariable regression was used to compute adjusted risk ratios (aRRs) of factors associated with MIS-C vs COVID-19.
Results: Of 1116 patients (median age, 9.7 years; 45% female), 539 (48%) were diagnosed with MIS-C and 577 (52%) with COVID-19. Compared with patients with COVID-19, patients with MIS-C were more likely to be 6 to 12 years old (40.8% vs 19.4%; absolute risk difference [RD], 21.4% [95% CI, 16.1%-26.7%]; aRR, 1.51 [95% CI, 1.33-1.72] vs 0-5 years) and non-Hispanic Black (32.3% vs 21.5%; RD, 10.8% [95% CI, 5.6%-16.0%]; aRR, 1.43 [95% CI, 1.17-1.76] vs White). Compared with patients with COVID-19, patients with MIS-C were more likely to have cardiorespiratory involvement (56.0% vs 8.8%; RD, 47.2% [95% CI, 42.4%-52.0%]; aRR, 2.99 [95% CI, 2.55-3.50] vs respiratory involvement), cardiovascular without respiratory involvement (10.6% vs 2.9%; RD, 7.7% [95% CI, 4.7%-10.6%]; aRR, 2.49 [95% CI, 2.05-3.02] vs respiratory involvement), and mucocutaneous without cardiorespiratory involvement (7.1% vs 2.3%; RD, 4.8% [95% CI, 2.3%-7.3%]; aRR, 2.29 [95% CI, 1.84-2.85] vs respiratory involvement). Patients with MIS-C had higher neutrophil to lymphocyte ratio (median, 6.4 vs 2.7, P < .001), higher C-reactive protein level (median, 152 mg/L vs 33 mg/L; P < .001), and lower platelet count (<150 ?103 cells/μL [212/523 {41%} vs 84/486 {17%}, P < .001]). A total of 398 patients (73.8%) with MIS-C and 253 (43.8%) with COVID-19 were admitted to the intensive care unit, and 10 (1.9%) with MIS-C and 8 (1.4%) with COVID-19 died during hospitalization. Among patients with MIS-C with reduced left ventricular systolic function (172/503, 34.2%) and coronary artery aneurysm (57/424, 13.4%), an estimated 91.0% (95% CI, 86.0%-94.7%) and 79.1% (95% CI, 67.1%-89.1%), respectively, normalized within 30 days.
Conclusions and relevance: This case series of patients with MIS-C and with COVID-19 identified patterns of clinical presentation and organ system involvement. These patterns may help differentiate between MIS-C and COVID-19.