Children with multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 may present with a "wide clinical spectrum" including Kawasaki disease (KD) and life-threatening shock, as well as milder forms marked chiefly by fever and inflammation, according to an international case series. One noteworthy finding is that a shorter duration of symptoms before admission appears to be associated with a worse outcome, report Dr. Alain Fraisse of Royal Brompton Hospital, in London, and colleagues in Pediatrics. The researchers took a look back at 183 children meeting the published definition of MIS-C from 33 hospitals in Europe, Asia and the U.S. who were discharged or died between March 1 and June 15. The cohort had a mean age of 7 years, 60% were male, 31% Black and 26% obese. In total, 114 children (62%) had evidence of current or recent SARS-CoV-2 infection. All of the children presented with fever and most (64%) with gastrointestinal symptoms; 43% presented with shock, which was associated with Black race, higher inflammation and imaging abnormalities. Overall, 39% of the children needed inotropic support, 24% needed mechanical ventilation and 2% required extracorporeal membrane oxygenation (ECMO). Three died. Twenty-seven children (15%) met criteria for Kawasaki disease (KD). These children were usually stable at admission and had fewer symptoms and less inflammation than other children with MIS-C. They did not experience shock and had few cardiac complications other than coronary-artery abnormalities. Their hospital stays were shorter, with fewer admissions to the pediatric intensive-care unit and less need for inotropic support and mechanical ventilation. However, one child with KD died suddenly in the setting of multiple giant aneurysms. The remaining 77 children (49%) with MIS-C did not experience shock and mainly had fever and inflammation. These children had a higher rate of coronary-artery abnormalities but less valvulitis, pericardial effusion and ventricular dysfunction, and they generally had a better outcome. After admission, 26 of 183 children (14%) experienced worse outcomes with escalation of care. A shorter duration of symptoms before admission was associated with worse outcome as measured by requiring inotropes, mechanical ventilation, or ECMO and/or death. "Our study is the first to reveal that a shorter period of symptoms before admission is a risk factor for worse outcome and for ECMO and/or death," the authors write. They note that this is currently the largest international series of children with MIS-C that reports outcomes after their full hospital course has been completed. "More studies encompassing larger numbers of patients are needed to better describe this new disease, its optimal treatment, and long-term monitoring," they say. —Reuters Staff Source
