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Multisystem inflammatory syndrome in children: A systematic review
Mubbasheer Ahmed1, Shailesh Advani2,3, Axel Moreira1
1Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is a dangerous condition linked to COVID-19. While most children survive with prompt care, long-term outcomes for MIS-C remain unknown.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Public health
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory condition associated with COVID-19.
- This syndrome presents a significant challenge in pediatric healthcare due to its novelty and potential severity.
Purpose of the Study:
- To systematically review and describe the clinical presentation, laboratory findings, imaging results, and outcomes of children diagnosed with MIS-C.
- To consolidate current knowledge on MIS-C to aid in its recognition and management.
Main Methods:
- A systematic review of observational studies published between January 1, 2020, and July 25, 2020.
- Searches were conducted across four medical databases, with data extraction and risk of bias assessment performed by two independent reviewers.
- The review was registered with PROSPERO (CRD42020191515).
Main Results:
- The review included 39 studies with 662 MIS-C patients; 71% required intensive care, and 1.7% died.
- Common symptoms included fever (100%), abdominal pain/diarrhea (73.7%), and vomiting (68.3%).
- Significant abnormalities were noted in inflammatory, coagulative, and cardiac markers, with 54% showing abnormal echocardiographs, including depressed ejection fraction in 45.1%.
Conclusions:
- MIS-C is a serious, potentially lethal pediatric illness linked to SARS-CoV-2.
- Prompt medical attention is crucial for survival, but the long-term health consequences of MIS-C are yet to be determined.
Background:
Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome, is a new dangerous childhood disease that is temporally associated with coronavirus disease 2019 (COVID-19). We aimed to describe the typical presentation and outcomes of children diagnosed with this hyperinflammatory condition.
Methods:
We conducted a systematic review to communicate the clinical signs and symptoms, laboratory findings, imaging results, and outcomes of individuals with MIS-C. We searched four medical databases to encompass studies characterizing MIS-C from January 1st, 2020 to July 25th, 2020. Two independent authors screened articles, extracted data, and assessed risk of bias. This review was registered with PROSPERO CRD42020191515.
Findings:
Our search yielded 39 observational studies (n = 662 patients). While 71·0% of children (n = 470) were admitted to the intensive care unit, only 11 deaths (1·7%) were reported. Average length of hospital stay was 7·9 ± 0·6 days. Fever (100%, n = 662), abdominal pain or diarrhea (73·7%, n = 488), and vomiting (68·3%, n = 452) were the most common clinical presentation. Serum inflammatory, coagulative, and cardiac markers were considerably abnormal. Mechanical ventilation and extracorporeal membrane oxygenation were necessary in 22·2% (n = 147) and 4·4% (n = 29) of patients, respectively. An abnormal echocardiograph was observed in 314 of 581 individuals (54·0%) with depressed ejection fraction (45·1%, n = 262 of 581) comprising the most common aberrancy.
Interpretation:
Multisystem inflammatory syndrome is a new pediatric disease associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is dangerous and potentially lethal. With prompt recognition and medical attention, most children will survive but the long-term outcomes from this condition are presently unknown.
Funding:
Parker B. Francis and pilot grant from 2R25-HL126140. Funding agencies had no involvement in the study.
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