tetano
Editor, Senior Moderator
Pediatrics
. 2021 Jul 15;e2021051155.
doi: 10.1542/peds.2021-051155. Online ahead of print.
Longitudinal Outcomes for Multisystem Inflammatory Syndrome in Children
Kanwal M Farooqi[SUP] 1 [/SUP], Angela Chan[SUP] 2 [/SUP], Rachel J Weller[SUP] 3 [/SUP], Junhui Mi[SUP] 4 [/SUP], Pengfei Jiang[SUP] 3 [/SUP], Elizabeth Abrahams[SUP] 3 [/SUP], Anne Ferris[SUP] 3 [/SUP], Usha S Krishnan[SUP] 3 [/SUP], Nikhil Pasumarti[SUP] 3 [/SUP], Sanghee Suh[SUP] 3 [/SUP], Amee M Shah[SUP] 3 [/SUP], Michael P DiLorenzo[SUP] 3 [/SUP], Philip Zachariah[SUP] 5 [/SUP], Joshua D Milner[SUP] 2 [/SUP], Erika B Rosenzweig[SUP] 3 [/SUP], Mark Gorelik[SUP] 2 [/SUP], Brett R Anderson, Columbia University Interdisciplinary MIS-C Follow-up Program and the CUIMC Pediatric/Adult Congenital Heart Research Collaborative
Affiliations
Abstract
Background: In spring 2020, a novel hyperinflammatory process associated with severe acute respiratory syndrome coronavirus 2 multisystem inflammatory syndrome in children (MIS-C) was described. The long-term impact remains unknown. We report longitudinal outcomes from a New York interdisciplinary follow-up program.
Methods: All children <21 years of age, admitted to NewYork-Presbyterian with MIS-C in 2020, were included. Children were followed at 1 to 4 weeks, 1 to 4 months, and 4 to 9 months postdischarge.
Results: In total, 45 children were admitted with MIS-C. The median time to last follow-up was 5.8 months (interquartile range 1.3-6.7). Of those admitted, 76% required intensive care and 64% required vasopressors and/or inotropes. On admission, patients exhibited significant nonspecific inflammation, generalized lymphopenia, and thrombocytopenia. Soluble interleukin (IL) IL-2R, IL-6, IL-10, IL-17, IL-18, and C-X-C Motif Chemokine Ligand 9 were elevated. A total of 80% (n = 36) had at least mild and 44% (n = 20) had moderate-severe echocardiographic abnormalities including coronary abnormalities (9% had a z score of 2-2.5; 7% had a z score > 2.5). Whereas most inflammatory markers normalized by 1 to 4 weeks, 32% (n = 11 of 34) exhibited persistent lymphocytosis, with increased double-negative T cells in 96% of assessed patients (n = 23 of 24). By 1 to 4 weeks, only 18% (n = 7 of 39) had mild echocardiographic findings; all had normal coronaries. At 1 to 4 months, the proportion of double-negative T cells remained elevated in 92% (median 9%). At 4 to 9 months, only 1 child had persistent mild dysfunction. One had mild mitral and/or tricuspid regurgitation.
Conclusions: Although the majority of children with MIS-C present critically ill, most inflammatory and cardiac manifestations in our cohort resolved rapidly.
. 2021 Jul 15;e2021051155.
doi: 10.1542/peds.2021-051155. Online ahead of print.
Longitudinal Outcomes for Multisystem Inflammatory Syndrome in Children
Kanwal M Farooqi[SUP] 1 [/SUP], Angela Chan[SUP] 2 [/SUP], Rachel J Weller[SUP] 3 [/SUP], Junhui Mi[SUP] 4 [/SUP], Pengfei Jiang[SUP] 3 [/SUP], Elizabeth Abrahams[SUP] 3 [/SUP], Anne Ferris[SUP] 3 [/SUP], Usha S Krishnan[SUP] 3 [/SUP], Nikhil Pasumarti[SUP] 3 [/SUP], Sanghee Suh[SUP] 3 [/SUP], Amee M Shah[SUP] 3 [/SUP], Michael P DiLorenzo[SUP] 3 [/SUP], Philip Zachariah[SUP] 5 [/SUP], Joshua D Milner[SUP] 2 [/SUP], Erika B Rosenzweig[SUP] 3 [/SUP], Mark Gorelik[SUP] 2 [/SUP], Brett R Anderson, Columbia University Interdisciplinary MIS-C Follow-up Program and the CUIMC Pediatric/Adult Congenital Heart Research Collaborative
Affiliations
- PMID: 34266903
- DOI: 10.1542/peds.2021-051155
Abstract
Background: In spring 2020, a novel hyperinflammatory process associated with severe acute respiratory syndrome coronavirus 2 multisystem inflammatory syndrome in children (MIS-C) was described. The long-term impact remains unknown. We report longitudinal outcomes from a New York interdisciplinary follow-up program.
Methods: All children <21 years of age, admitted to NewYork-Presbyterian with MIS-C in 2020, were included. Children were followed at 1 to 4 weeks, 1 to 4 months, and 4 to 9 months postdischarge.
Results: In total, 45 children were admitted with MIS-C. The median time to last follow-up was 5.8 months (interquartile range 1.3-6.7). Of those admitted, 76% required intensive care and 64% required vasopressors and/or inotropes. On admission, patients exhibited significant nonspecific inflammation, generalized lymphopenia, and thrombocytopenia. Soluble interleukin (IL) IL-2R, IL-6, IL-10, IL-17, IL-18, and C-X-C Motif Chemokine Ligand 9 were elevated. A total of 80% (n = 36) had at least mild and 44% (n = 20) had moderate-severe echocardiographic abnormalities including coronary abnormalities (9% had a z score of 2-2.5; 7% had a z score > 2.5). Whereas most inflammatory markers normalized by 1 to 4 weeks, 32% (n = 11 of 34) exhibited persistent lymphocytosis, with increased double-negative T cells in 96% of assessed patients (n = 23 of 24). By 1 to 4 weeks, only 18% (n = 7 of 39) had mild echocardiographic findings; all had normal coronaries. At 1 to 4 months, the proportion of double-negative T cells remained elevated in 92% (median 9%). At 4 to 9 months, only 1 child had persistent mild dysfunction. One had mild mitral and/or tricuspid regurgitation.
Conclusions: Although the majority of children with MIS-C present critically ill, most inflammatory and cardiac manifestations in our cohort resolved rapidly.