Multisystem Inflammatory Syndrome Is Rare But Severe in Paediatric Patients With COVID-19
By Shazia Qureshi
AMSTERDAM, the Netherlands -- November 2, 2020 -- Among paediatric patients diagnosed with coronavirus disease 2019 (COVID-19), multisystem inflammatory syndrome in children (MIS-C) is a rare but clinically severe spectrum and comes with a high mortality rate, according to a study presented at the Virtual 38th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID).
Thais T. Fink, MD, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil, and colleagues evaluated a total of 371 patients aged younger than 18 years at their hospital whose symptoms initially suggested a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was laboratory-confirmed in 66 (18%) of the patients.
For the diagnosis of MIS-C -- knowledge of which was rapidly evolving in the first few months of the pandemic -- the researchers looked to the definition that was valid at the time from the US Centers for Disease Control and Prevention (CDC), and found that 6 of the 66 paediatric patients had MIS-C.
The CDC’s criteria for diagnosing MIS-C at the time of the analysis (June 2020) included age
Then, among the 66 patients with laboratory-confirmed SARS-CoV-2, the researchers compared the group of 6 patients with MIS-C to the group of 60 patients without MIS-C, and the results revealed several significant differences between the 2 groups.
Cough was a symptom reported by a significantly higher proportion of children with SARS-CoV-2 and MIS-C, compared with the children with SARS-CoV-2 but without MIS-C (83% vs 37%; P = .038). Diarrhoea, vomiting, and/or abdominal pain were also more common (67% vs 22%; P = .034).
Paediatric severe acute respiratory syndrome -- defined as the presence of ≥1 of dyspnoea, oxygen saturation P = .008).
Arterial hypotension (50% vs 3%; P = .004) was also more common among patients with MIS-C, as was hypoxaemia (83% vs 23%; P = .006).
Cardiac abnormalities were found in all patients with MIS-C, compared with just 2% of patients without MIS-C (P
In the MIS-C group, 67% of patients died, compared with 3% of patients without MIS-C (P
Several inflammatory markers were elevated among the patients with MIS-C, including median levels of C-reactive protein (171.65 vs 6.03 mg/L; P = .003), D-dimer (13,412 vs 1208 ng/mL; P = .010), and ferritin (3660 vs 3295 ng/mL; P = .007).
Children with MIS-C more often required oxygen therapy (100% vs 33%; P = .003), intravenous immunoglobulins (67% vs 2%; PP = 0.002), and aspirin (50% vs 0%; P
Several in-hospital outcomes were also more common among the MIS-C group compared with paediatric patients without MIS-C, including admission to the paediatric intensive care unit (100% vs 60%; P = .003), the need for mechanical ventilation (83% vs 7%; PP
In logistic regression analyses, both gastrointestinal symptoms (odds ratio [OR] = 10.98; 95% confidence interval [CI], 1.20-100.86; P = .034) and hypoxaemia (OR = 16.85; 95% CI, 1.34-211.80; P = .029) were significantly associated with MIS-C.
“This emphasises the importance of investigating MIS-C for paediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxaemia,” said Dr. Fink.
[Presentation title: Severe Clinical Spectrum With High Mortality COVID-19 in Pediatric Patients With Multisystem Inflammatory Syndrome (MIS-C). Session: Late-Breaking Oral Presentations 2]