Details

Autor(en) / Beteiligte

• Feldstein, Leora R
• Tenforde, Mark W
• Friedman, Kevin G
• Newhams, Margaret
• Rose, Erica Billig
• Dapul, Heda
• Soma, Vijaya L
• Maddux, Aline B
• Mourani, Peter M
• Bowens, Cindy
• Maamari, Mia
• Hall, Mark W
• Riggs, Becky J
• Giuliano, Jr, John S
• Singh, Aalok R
• Li, Simon
• Kong, Michele
• Schuster, Jennifer E
• McLaughlin, Gwenn E
• Schwartz, Stephanie P
• Walker, Tracie C
• Loftis, Laura L
• Hobbs, Charlotte V
• Halasa, Natasha B
• Doymaz, Sule
• Babbitt, Christopher J
• Hume, Janet R
• Gertz, Shira J
• Irby, Katherine
• Clouser, Katharine N
• Cvijanovich, Natalie Z
• Bradford, Tamara T
• Smith, Lincoln S
• Heidemann, Sabrina M
• Zackai, Sheemon P
• Wellnitz, Kari
• Nofziger, Ryan A
• Horwitz, Steven M
• Carroll, Ryan W
• Rowan, Courtney M
• Tarquinio, Keiko M
• Mack, Elizabeth H
• Fitzgerald, Julie C
• Coates, Bria M
• Jackson, Ashley M
• Young, Cameron C
• Son, Mary Beth F
• Patel, Manish M
• Newburger, Jane W
• Randolph, Adrienne G

Titel

Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19

Ist Teil von

• JAMA : the journal of the American Medical Association, 2021-03, Vol.325 (11), p.1074

Ort / Verlag

United States

Erscheinungsjahr

2021

Quelle

MEDLINE

Beschreibungen/Notizen

• Refinement of criteria for multisystem inflammatory syndrome in children (MIS-C) may inform efforts to improve health outcomes. To compare clinical characteristics and outcomes of children and adolescents with MIS-C vs those with severe coronavirus disease 2019 (COVID-19). 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. SARS-CoV-2. 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. 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. 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.