Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study

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dc.contributor.authorRenson, Thomas
dc.contributor.authorForkert, Nils D.
dc.contributor.authorAmador, Kimberly
dc.contributor.authorMiettunen, Paivi
dc.contributor.authorParsons, Simon J.
dc.contributor.authorDhalla, Muhammed
dc.contributor.authorJohnson, Nicole A.
dc.contributor.authorLuca, Nadia
dc.contributor.authorSchmeling, Heinrike
dc.contributor.authorStevenson, Rebeka
dc.contributor.authorTwilt, Marinka
dc.contributor.authorHamiwka, Lorraine
dc.contributor.authorBenseler, Susanne
dc.date.accessioned2023-04-16T00:03:20Z
dc.date.available2023-04-16T00:03:20Z
dc.date.issued2023-04-12
dc.date.updated2023-04-16T00:03:20Z
dc.description.abstractAbstract Background Multisystem inflammatory syndrome in children (MIS-C) is a severe disease with an unpredictable course and a substantial risk of cardiogenic shock. Our objectives were to (a) compare MIS-C phenotypes across the COVID-19 pandemic, (b) identify features associated with intensive care need and treatment with biologic agents. Methods Youth aged 0–18 years, fulfilling the World Health Organization case definition of MIS-C, and admitted to the Alberta Children’s Hospital during the first four waves of the COVID-19 pandemic (May 2020-December 2021) were included in this cohort study. Demographic, clinical, biochemical, imaging, and treatment data were captured. Results Fifty-seven MIS-C patients (median age 6 years, range 0–17) were included. Thirty patients (53%) required intensive care. Patients in the third or fourth wave (indicated as phase 2 of the pandemic) presented with higher peak ferritin (µg/l, median (IQR) = 1134 (409–1806) vs. 370 (249–629), P = 0.001), NT-proBNP (ng/l, median (IQR) = 12,217 (3013–27,161) vs. 3213 (1216–8483), P = 0.02) and D-dimer (mg/l, median (IQR) = 4.81 (2.24–5.37) vs. 2.01 (1.27–3.34), P = 0.004) levels, and higher prevalence of liver enzyme abnormalities (n(%) = 17 (68) vs. 11 (34), P = 0.02), hypoalbuminemia (n(%) = 24 (100) vs. 25 (81), P = 0.03) and thrombocytopenia (n(%) 18 (72) vs. 11 (34), P = 0.007) compared to patients in the first two waves (phase 1). These patients had a higher need of non-invasive/mechanical ventilation (n(%) 4 (16) vs. 0 (0), P = 0.03). Unsupervised clustering analyses classified 47% of the patients in the correct wave and 74% in the correct phase of the pandemic. NT-proBNP was the only significant contributor to the need for intensive care in all applied multivariate regression models. Treatment with biologic agents was significantly associated with peak CRP (mg/l (median, IQR = 240.9 (132.9-319.4) vs. 155.8 (101.0-200.7), P = 0.02) and ferritin levels (µg/l, median (IQR) = 1380 (509–1753) vs. 473 (280–296)). Conclusions MIS-C patients in a later stage of the pandemic displayed a more severe phenotype, reflecting the impact of distinct SARS-CoV-2 variants. NT-proBNP emerged as the most crucial feature associated with intensive care need, underscoring the importance of monitoring.
dc.identifier.citationPediatric Rheumatology. 2023 Apr 12;21(1):33
dc.identifier.urihttps://doi.org/10.1186/s12969-023-00815-w
dc.identifier.urihttps://prism.ucalgary.ca/handle/1880/116075
dc.identifier.urihttps://dx.doi.org/10.11575/PRISM/dspace/40921
dc.language.rfc3066en
dc.rights.holderThe Author(s)
dc.titleDistinct phenotypes of multisystem inflammatory syndrome in children: a cohort study
dc.typeJournal Article
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