February 24, 2021
3 min read
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Feldstein does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.
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A study of more than 1,000 patients identified cardiac involvement, age, and race as attributes that might differentiate multisystem inflammatory syndrome in children from severe COVID-19, researchers reported in JAMA.
CDC epidemiologist Leora R. Feldstein, PhDand colleagues ran a case series that included 1,116 patients under the age of 21 from the Overcoming COVID-19 network who were hospitalized from March 15 to October 31 in 31 states with MIS-C and 577 (52%)% ) with acute COVID-19.
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Of those with MIS-C, 52% had a positive reverse transcriptase PCR test for SARS-CoV-2, 45% were only positive for antibodies, 31% were positive for both and 19% had not carried out an antibody test, Feldstein and colleagues reported .
Among the symptoms and signs, they found that only the mucocutaneous findings differed in their prevalence and in 66.8% (95% CI, 63% -71%) of patients with MIS-C versus 10.2% (95% CI, 8% – occurred). 13%) of patients with COVID-19.
Heart involvement was more common in participants with MIS-C (66.7%; 95% CI, 63% -71%) than in COVID-19 (11.8%; 95% CI, 9% -15%). In both cohorts, 80% of the patients had severe respiratory involvement.
Additionally, patients diagnosed with MIS-C were more likely to be 6 to 12 years old (40.8% versus 19.4%; risk difference) [RD] = 21.4% [95% CI, 16.1%-26.7%]); be black (32.3% versus 21.5%; RD = 10.8% [95% CI, 5.6%-16%]) and have no underlying conditions (69% vs 37.9%; RD = 31.1% [95% CI, 25.5%-36.6%]).
After adjusting for covariates, the authors reported that the risk of MIS-C was higher in people aged 6 to 12 years than in people aged 0 to 5 years (aRR, 1.51; 95% CI, 1, 33-1.72) patients who were black compared to those who were white (adjusted RR 1.43; 95% CI 1.17-1.76).
In addition, the likelihood of cardiorespiratory involvement was higher in patients with MIS-C than in patients with COVID-19 (56% versus 8.8%; RD = 47.2; 95% CI, 42.4% -52%), cardiovascular with no respiratory involvement (10.6%) vs 2.9%; RD = 7.7%; 95% CI, 4.7% -10.6%) and mucocutaneously without cardiorespiratory involvement (7.1% vs 2.3%; RD = 4.8%; 95% CI, 2.3% -7.3% ).
A MIS-C diagnosis was also more likely in patients with cardiorespiratory involvement than in patients with only breathing involvement (aRR = 2.99; 95% CI, 2.55-3.5) and mucocutaneously without cardiorespiratory involvement (aRR = 2.29 ; 95% CI, 1.84-) 2.85).
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David Cennimo, MD
David Cennimo
This report is very interesting and up-to-date and helps the attending physician grappling with the diagnostic uncertainty as to whether the child has severe COVID-19 or MIS-C.
The authors examined data from March to October 2020 from a study network from 31 countries; So this study is well represented. The children had MIS-C if they met the CDC criteria – – Fever, signs of inflammation in the laboratory, severe illness with at least two organ systems, current or recent exposure, or positive SARS-CoV-2 tests. Patients were assumed to have severe COVID-19 if they showed signs of a current infection and severe organ involvement in at least one organ system.
The network reported 1,314 children (under the age of 21) who were hospitalized during the period with COVID-19. A total of 198 were excluded because they did not meet the criteria for serious illness. Ultimately, of the 1,116 remaining cases, 48% were classified as MIS-C and 52% as severe COVID-19.
This fits in with many of our “real” experiences of seeing both manifestations of the infection. The signs and symptoms present were similar, with the exception of significantly more mucocutaneous findings in MIS-C. This is not surprising as MIS-C was originally very similar to Kawasaki disease for the same reasons. Both groups had significant airway involvement, but cardiac involvement was much more common in patients with MIS-C (66.7% versus 11.8%).
Most children with decreased ejection fraction normalized within 1 to 2 weeks of their MIS-C diagnosis. Children suffering from MIS-C also showed labs compatible with higher levels of inflammation. The risk of being diagnosed with MIS-C was highest in children ages 6 to 12 and non-Hispanic blacks.
All in all, I think this study helps differentiate the clinical patterns that differentiate severe COVID-19 from MIS-C, and gives us some comfort that most patients suffering from MIS-C will in the long run do well.
David Cennimo, MD
Clinician and Assistant Professor of Infectious Diseases in Adults
Rutgers New Jersey Medical School
Disclosure: Cennimo does not report any relevant financial information.
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