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Coronary arteries were evaluated in of patients Among these, 57 patients In this case series comparing children and adolescents with MIS-C vs those with severe COVID, MIS-C was distinguished by certain demographic features and clinical presentations including being aged 6 to 12 years, being of non-Hispanic Black race, having severe cardiovascular or mucocutaneous involvement, and having more extreme inflammation.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. Echocardiographic findings during hospitalization and postdischarge were obtained from medical records.


Mucocutaneous involvement was defined as presence of any of the following: rash, inflammation of the oral mucosa, conjunctivitis, and extremity findings, including erythema or edema of the hands or feet, or periungual peeling. Risk differences were calculated using the adjrr command in Stata. Five patients were censored before documented resolution of reduced left ventricular EF at a median time of 2 days range, days ; all other patients had resolution documented by days. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

In contrast, patients with COVID were more likely to have 1 or more underlying conditions; respiratory without cardiovascular involvement; or hematologic, neurologic, or gastrointestinal involvement without cardiovascular, respiratory, or mucocutaneous involvement.

Characteristics and outcomes of us children and adolescents with multisystem inflammatory syndrome in children (mis-c) compared with severe acute covid

Patients from the registry were included if they were hospitalized for acute illness at a participating site, were younger than 21 years old, and met criteria for MIS-C or severe acute COVID henceforth referred to as COVIDafter adjudication by site and coordinating center principal investigators. Other complications as determined by site clinicians included ileitis, colitis, or mesenteric adenitis.

Obesity was classified either by clinician diagnosis or, given underreporting, 5 based on national reference standards for body mass index if aged at least 2 years. The of patients excluded from the regression analyses varied based on the variables included in the model and ranged from 0 to depending on the laboratory marker of interest. Ten patients 1.

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Patients from both groups commonly presented with a variety of constitutional, gastrointestinal, and upper or lower respiratory s or symptoms on admission. Final date of follow-up was January 5, 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 or recent exposure with no alternate diagnosis. However, Matsubara et al 30 demonstrated persistent abnormalities in strain and diastolic function in patients with MIS-C and normal EF.

These data, together with literature in adult patients with COVID, 33 suggest that subclinical myocardial injury may persist even when traditional measures of LV systolic function are normal. We compared the association of selected baseline patient demographic and clinical characteristics with the diagnosis of MIS-C vs COVID by fitting a Poisson regression with robust variance estimates to generate risk ratios.

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First, data collection through in-depth abstraction of routine clinical documentation is subject to incomplete reporting. Cardiovascular pediatric Severe Organ Failure Assessment pSOFA scores range from 0 to 4 and were documented daily through 7 days, twice weekly through day 22, then at day Scores of 2 to 4, indicating vasopressor use, are presented in the figure.

Nine patients were censored before documented resolution of coronary artery aneurysms at a median time of 4 days range, days ; all other patients had resolution documented by 76 days. Laboratory cutoffs were dichotomized based on the cutoff for thrombocytopenia or around median baseline values in the full cohort CRP and NLR. Based on emerging evidence from small case series and 1 latent class analysis, 81114 we evaluated differences in 5 mutually exclusive severe organ involvement sub of MIS-C and COVID 1 cardiorespiratory involvement, 2 cardiovascular without respiratory involvement, 3 respiratory without cardiovascular involvement, 4 mucocutaneous without cardiovascular or respiratory involvement, and 5 other organ system involvement without cardiovascular, respiratory, or mucocutaneous involvement.

Please see our commenting policy for details. Most severe cardiovascular involvement from MIS-C, including left ventricular dysfunction and coronary artery aneurysms, resolved within 30 days. From March 15 to October 31,hospitalized children and adolescents younger than 21 years of age with COVID—related illness were reported from 66 hospitals in 31 states eTable 3 in the Supplement.

Not all submitted comments are published.

Misclassification of these patients might impede optimal treatment if the pathogenesis differs between MIS-C and COVID; however, it is possible that anti-inflammatory agents like steroids could be beneficial for both.

Coronary artery aneurysms were generally small in size and regressed to normal internal lumen diameter within several weeks in a population that was often treated with IVIG, an effective therapy for reduction of prevalence of aneurysms in Kawasaki disease. We assessed cardiac outcomes using Kaplan-Meier estimates up to 90 days after hospital admission when available among patients with MIS-C and cardiac involvement.

A total of patients International reports of coronavirus disease COVID —related severe complications in children began in April when predominantly healthy children were hospitalized with cardiogenic shock or Kawasaki disease—like presentations temporally associated with severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 infection. Both groups often required intensive care unit support, more commonly in the MIS-C group.

Some patients had missing information on mechanical ventilator or vasopressor use and are excluded.

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Because of the potential for type I error due to multiple comparisons, findings for analyses should be interpreted as exploratory. Tables below the x-axis present the of patients with MIS-C and COVID still hospitalized by admission day, the on mechanical ventilation or receiving vasopressor support, and the cumulative deaths during index hospitalization. A risk ratio greater than 1 represents a higher relative risk of MIS-C in the respective row relative to the referent group within that category. The recovery of LVEF within a few weeks of diagnosis in most patients with MIS-C suggests that LV dysfunction likely from severe systemic inflammation and acute stress more often than from ischemia or direct virus-mediated myocardial damage.

Other complications as determined by site clinicians included hemolytic uremic syndrome, anemia requiring transfusion, and pancytopenia.

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Encephalitis, aseptic meningitis, or demyelinating disorder eg, acute disseminated encephalomyelitis diagnosed by a neurologist. Analyses were conducted in R version 3. Receipt of mechanical ventilation or any type of supplemental oxygen or increased support for patients receiving respiratory support at baseline. Of patients median age, 9. Adjusting for other covariates, risk of MIS-C nlr was higher for patients aged 6 to 12 years vs 0 to 5 years aRR, 1.

Differences in the epidemiology, clinical characteristics, types of complications, as well as hospital and postdischarge outcomes were compared between these groups to identify features distinguishing MIS-C from COVID The study was reviewed by the CDC and was conducted consistent with applicable federal law and CDC policy, which included a waiver of consent. Cardiac magnetic resonance imaging and the rare endomyocardial biopsy or postmortem specimen may further help to clarify the underlying pathology and mechanisms of myocardial involvement in MIS-C.

Importance Refinement of sex for multisystem inflammatory syndrome in children MIS-C may inform efforts to improve health outcomes. The information will be posted with your response. Patients were classified as having coronary artery Henderson if either the right coronary artery or left anterior descending z score meet 2. Main Outcomes and Measures Presenting symptoms, organ system complications, laboratory biomarkers, interventions, and clinical outcomes.

Third, participating hospitals may not be generalizable and likely overrepresented patients seeking care at tertiary care centers. Respiratory support and cardiovascular pediatric Severe Organ Failure Assessment scores based on vasoactive agent support were also documented throughout hospitalization eTable 2 in the Supplement. Francis Fellowship during the conduct of the study.

Patients were censored when resolution was documented or, if resolution was not confirmed, by date of last echocardiographic evaluation. Corresponding Author: Adrienne G. Published Online: February 24, Author Contributions : Dr Patel had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Future studies using standardized protocols and adult laboratory interpretation will build on the of this study and others.

Patients were evaluated from the day of first echocardiographic evaluation and censored on the day when repeat echocardiograph showed recovery or on the day of their last repeat echocardiogram if they had not recovered through 40 days.

Patients with MIS-C had higher neutrophil to lymphocyte ratio median, 6. Missing data were not imputed for common laboratory markers of interest. To understand the longer-term implications for myocardial health, including risk for myocardial fibrosis and diastolic dysfunction, it is critical to have comprehensive assessment of LV systolic and diastolic function in a large, multicenter cohort followed up longitudinally with centralized review of cardiac imaging.

On August 13,the registry was restricted to patients admitted to the intensive care unit or high-acuity stepdown unit for patients without MIS-C. This study has several limitations. For patients with MIS-C and COVID, the percentages receiving invasive mechanical ventilation and vasoactive agents were plotted graphically throughout the hospitalization.

Research personnel at each site abstracted data and were part of a large research network with extensive data collection experience and intensive data clarification procedures. Percentages receiving mechanical ventilator or vasopressor support by day of admission use the full denominators specified at day 1 the initial day of hospitalization. Compared with patients with respiratory involvement alone, MIS-C diagnosis was more likely in patients with cardiorespiratory involvement aRR, 2. Question How do the characteristics and outcomes of children and adolescents with multisystem inflammatory syndrome in children MIS-C compare with severe coronavirus disease COVID?

Second, missing data were not imputed and missingness might be nonrandom.

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The regression model RDs are shown in eTable 6 in the Supplement. In patients with MIS-C, among Of the patients By Kaplan-Meier analysis with censoring at the last echocardiogram, The 1 patient without normalization documented within 90 days who had further echocardiographic analysis had a normal LVEF at days. Setting, De, and Participants Case series of patients aged younger than 21 years hospitalized between March 15 and October 31,at 66 US hospitals in 31 states.

We collected race and ethnicity information from hospital medical records as reported by the site clinicians who cared for the patients. Fifth, the efficacies of different immunomodulatory regimens on recovery of LV function in the current study were not examined. However, the mild severity and rapid resolution may suggest that coronary enlargement in MIS-C more often from vasodilation in the setting of a highly proinflammatory milieu, 34 rather than from destruction of the arterial wall by inflammatory cells.