Journal article
Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19
JAMA : the journal of the American Medical Association, Vol.325(11), pp.1074-1087
03/16/2021
DOI: 10.1001/jama.2021.2091
PMCID: PMC7905703
PMID: 33625505
Abstract
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.
Details
- Title: Subtitle
- Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19
- Creators
- Leora R Feldstein - United States Public Health ServiceMark W Tenforde - Centers for Disease Control and PreventionKevin G Friedman - Harvard UniversityMargaret Newhams - Harvard UniversityErica Billig Rose - United States Public Health ServiceHeda Dapul - New York UniversityVijaya L Soma - New York UniversityAline B Maddux - University of Colorado DenverPeter M Mourani - University of Colorado DenverCindy Bowens - The University of Texas at DallasMia Maamari - The University of Texas at DallasMark W Hall - Nationwide Children's HospitalBecky J Riggs - Johns Hopkins UniversityJohn S Giuliano Jr - Yale UniversityAalok R Singh - Westchester Medical CenterSimon Li - Rutgers, The State University of New JerseyMichele Kong - University of Alabama at BirminghamJennifer E Schuster - Children's Mercy HospitalGwenn E McLaughlin - University of MiamiStephanie P Schwartz - University of North Carolina at Chapel HillTracie C Walker - University of North Carolina at Chapel HillLaura L Loftis - Baylor College of MedicineCharlotte V Hobbs - University of MississippiNatasha B Halasa - Vanderbilt UniversitySule Doymaz - SUNY Downstate Health Sciences UniversityChristopher J Babbitt - California State University, Long BeachJanet R Hume - University of MinnesotaShira J Gertz - Saint Barnabas Medical CenterKatherine Irby - University of Arkansas for Medical SciencesKatharine N Clouser - Rutgers, The State University of New JerseyNatalie Z Cvijanovich - UCSF Benioff Children's HospitalTamara T Bradford - Boston Children's HospitalLincoln S Smith - University of WashingtonSabrina M Heidemann - Central Michigan UniversitySheemon P Zackai - Icahn School of Medicine at Mount SinaiKari Wellnitz - University of IowaRyan A Nofziger - Boston Children's HospitalSteven M Horwitz - Rutgers, The State University of New JerseyRyan W Carroll - Harvard UniversityCourtney M Rowan - Indiana UniversityKeiko M Tarquinio - Emory UniversityElizabeth H Mack - Medical University of South CarolinaJulie C Fitzgerald - University of PennsylvaniaBria M Coates - Northwestern UniversityAshley M Jackson - Centers for Disease Control and PreventionCameron C Young - Harvard UniversityMary Beth F Son - Harvard UniversityManish M Patel - United States Public Health ServiceJane W Newburger - Harvard UniversityAdrienne G Randolph - Harvard UniversityOvercoming COVID-19 Investigators
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.325(11), pp.1074-1087
- DOI
- 10.1001/jama.2021.2091
- PMID
- 33625505
- PMCID
- PMC7905703
- NLM abbreviation
- JAMA
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Language
- English
- Date published
- 03/16/2021
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984353838602771
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