Carles Bautista-Rodriguez1,2,3, Joan Sanchez-de-Toledo4,5,3, Bradley C Clark6,7, Jethro Herberg8,9, Fanny Bajolle10,11, Paula C Randanne4, Diana Salas-Mera12, Sandrine Foldvari1,2, Devyani Chowdhury13, Ricardo Munoz14, Francesco Bianco15, Yogen Singh16,17, Michael Levin8,9, Damien Bonnet10,11, Alain Fraisse18,2. 1. Paediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom. 2. National Heart and Lung Institute and. 3. Contributed equally as co-first authors. 4. Department of Pediatric Cardiology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain. 5. Department of Critical Care Medicine, University of Pittsburg Medical Center Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania. 6. Division of Cardiology, Children's Hospital at Montefiore, New York, New York. 7. Department of Pediatrics, Albert Einstein College of Medicine, New York, New York. 8. Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom. 9. Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London, London, United Kingdom. 10. M3C-Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. 11. Université de Paris, Paris, France. 12. Department of Pediatric Cardiology, Hospital Universitario La Paz, Madrid, Spain. 13. Cardiology Care for Children, Lancaster, Pennsylvania. 14. Cardiac Critical Care Medicine, Children's National Hospital, Washington, District of Columbia. 15. AOU Ospedali Riuniti, Ancona, Italy. 16. NICU, Cambridge University Hospitals, Cambridge, United Kingdom; and. 17. School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom. 18. Paediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom; a.fraisse@rbht.nhs.uk.
Abstract
OBJECTIVES: To describe presentation, hospital course, and predictors of bad outcome in multisystem inflammatory syndrome in children (MIS-C). METHODS: Retrospective data review of a case series of children meeting the published definition for MIS-C who were discharged or died between March 1, 2020, and June 15, 2020, from 33 participating European, Asian, and American hospitals. Data were collected through a Web-based survey and included clinical, laboratory, electrocardiographic, and echocardiographic findings and treatment management. RESULTS: We included 183 patients with MIS-C: male sex, 109 (59.6%); mean age 7.0 ± 4.7 years; Black race, 56 (30.6%); obesity, 48 (26.2%). Overall, 114 of 183 (62.3%) had evidence of severe acute respiratory syndrome coronavirus 2 infection. All presented with fever, 117 of 183 (63.9%) with gastrointestinal symptoms, and 79 of 183 (43.2%) with shock, which was associated with Black race, higher inflammation, and imaging abnormalities. Twenty-seven patients (14.7%) fulfilled criteria for Kawasaki disease. These patients were younger and had no shock and fewer gastrointestinal, cardiorespiratory, and neurologic symptoms. The remaining 77 patients (49.3%) had mainly fever and inflammation. Inotropic support, mechanical ventilation, and extracorporeal membrane oxygenation were indicated in 72 (39.3%), 43 (23.5%), and 4 (2.2%) patients, respectively. A shorter duration of symptoms before admission was found to be associated with poor patient outcome and for extracorporeal membrane oxygenation and/or death, with 72.3% (95% confidence interval: 0.56-0.90; P = .006) increased risk per day reduction and 63.3% (95% confidence interval: 0.47-0.82; P < .0001) increased risk per day reduction respectively. CONCLUSIONS: In this case series, children with MIS-C presented with a wide clinical spectrum, including Kawasaki disease-like, life-threatening shock and milder forms with mainly fever and inflammation. A shorter duration of symptoms before admission was associated with a worse outcome.
OBJECTIVES: To describe presentation, hospital course, and predictors of bad outcome in multisystem inflammatory syndrome in children (MIS-C). METHODS: Retrospective data review of a case series of children meeting the published definition for MIS-C who were discharged or died between March 1, 2020, and June 15, 2020, from 33 participating European, Asian, and American hospitals. Data were collected through a Web-based survey and included clinical, laboratory, electrocardiographic, and echocardiographic findings and treatment management. RESULTS: We included 183 patients with MIS-C: male sex, 109 (59.6%); mean age 7.0 ± 4.7 years; Black race, 56 (30.6%); obesity, 48 (26.2%). Overall, 114 of 183 (62.3%) had evidence of severe acute respiratory syndrome coronavirus 2 infection. All presented with fever, 117 of 183 (63.9%) with gastrointestinal symptoms, and 79 of 183 (43.2%) with shock, which was associated with Black race, higher inflammation, and imaging abnormalities. Twenty-seven patients (14.7%) fulfilled criteria for Kawasaki disease. These patients were younger and had no shock and fewer gastrointestinal, cardiorespiratory, and neurologic symptoms. The remaining 77 patients (49.3%) had mainly fever and inflammation. Inotropic support, mechanical ventilation, and extracorporeal membrane oxygenation were indicated in 72 (39.3%), 43 (23.5%), and 4 (2.2%) patients, respectively. A shorter duration of symptoms before admission was found to be associated with poor patient outcome and for extracorporeal membrane oxygenation and/or death, with 72.3% (95% confidence interval: 0.56-0.90; P = .006) increased risk per day reduction and 63.3% (95% confidence interval: 0.47-0.82; P < .0001) increased risk per day reduction respectively. CONCLUSIONS: In this case series, children with MIS-C presented with a wide clinical spectrum, including Kawasaki disease-like, life-threatening shock and milder forms with mainly fever and inflammation. A shorter duration of symptoms before admission was associated with a worse outcome.
Authors: Vanessa Sancho-Shimizu; Petter Brodin; Aurélie Cobat; Catherine M Biggs; Julie Toubiana; Carrie L Lucas; Sarah E Henrickson; Alexandre Belot; Stuart G Tangye; Joshua D Milner; Michael Levin; Laurent Abel; Dusan Bogunovic; Jean-Laurent Casanova; Shen-Ying Zhang Journal: J Exp Med Date: 2021-06-07 Impact factor: 14.307
Authors: Ashraf S Harahsheh; Anita Krishnan; Roberta L DeBiasi; Laura J Olivieri; Christopher Spurney; Mary T Donofrio; Russell R Cross; Matthew P Sharron; Lowell H Frank; Charles I Berul; Adam Christopher; Niti Dham; Hemalatha Srinivasalu; Tova Ronis; Karen L Smith; Jaclyn N Kline; Kavita Parikh; David Wessel; James E Bost; Sarah Litt; Ashley Austin; Jing Zhang; Craig A Sable Journal: Cardiol Young Date: 2021-08-05 Impact factor: 1.023