Predictors of severe illness in children with multisystem in

Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study

Background: SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time.

Methods: We obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement.

Results: Of 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13–17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6–12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 μg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI −0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%).

Interpretation: We observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined.

Related Keywords

Costa Rica , United States , Canada , Iran , Tehran , Calgary , Alberta , Belgium , Belgian , Canadian , Dara Petel , Sarah Tehseen , Jared Bullard , Michelle Barton , Peter Gill , Marie Astrid Lefebvre , E Ann Yeh , Sanofi Pasteur , Shaun Morris , Ali Manafi , Joan Robinson , Alison Lopez , Tammie Dewan , Rupeena Purewal , Jesse Papenburg , Kirk Leifso , Janell Lautermilch , Adriana Yock Corrales , Jacqueline Wong , Ashley Roberts , Nicole Le Saux , Rolando Ulloa Gutierrez , Suzette Cooke , Marcela Hernandezde Mezerville , Gabriela Ivankovich Escoto , Jennifer Bowes , Lea Restivo , Manish Sadarangani , Joanna Merckx , Helena Brenes Chacon , Cheryl Foo , Ann Bayliss , Alejandra Soriano Fallas , Alireza Nateghian , Sick Kids Hospital Foundation , Glaxosmithkline , University Of Alberta , University Of Alberta Pro , Care Section Of The Canadian Pediatric Society , Manitoba Medical Service Foundation , Novartis , Pfizer , Royal College Of Paediatrics , Astrazeneca , Research Manitoba , Canadian Institutes For Health Research , Child Health , Centers For Disease , National Advisory Committee On Immunization , World Health Organization , Verity Pharmaceuticals , Association Of Medical Microbiology , University Of Calgary , Public Health Belgium , Janeway Foundation Research Grant , Department Of Pediatrics , Belgian Pediatric Task , Royal College , Disease Control , San Jos , Observational Studies , Supplementary Table , Supplementary Figure , Supplementary Methods , College Station , Merieux Canada , Belgian Pediatric Task Force , Ann Yeh , Horizon Therapeutics , Multiple Sclerosis , Related Disorders , Multiple Sclerosis Journal , National Advisory Committee , Canadian Institutes , Health Research , Complex Care Section , Canadian Pediatric , Medical Microbiology , Tala El Tal , Ari Bitnun , Behzad Haghighi Aski , Open Access , Creative Commons Attribution ,

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