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COVID-19 and multisystem inflammatory syndrome in children: A systematic review and meta-analysis
Jun Yasuhara1, Kae Watanabe2, Hisato Takagi3
1Center for Cardiovascular Research, The Abigail Wexner Research Institute and The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is linked to COVID-19, often causing gastrointestinal and cardiac issues. MIS-C presents differently from Kawasaki disease and can lead to organ failure, though most patients recover.
Area of Science:
- Pediatric infectious diseases
- Critical care medicine
- Epidemiology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) is a growing concern.
- Understanding MIS-C's clinical features and its distinction from Kawasaki disease is crucial.
Purpose of the Study:
- To investigate the epidemiology and clinical course of MIS-C.
- To delineate the distinct clinical features of MIS-C compared to Kawasaki disease.
Main Methods:
- A systematic literature search was conducted on PubMed and EMBASE up to August 30, 2020.
- Meta-analysis of observational studies involving 917 MIS-C patients was performed to pool data on demographics, symptoms, treatments, and outcomes.
Main Results:
- The study identified 917 MIS-C patients, with common manifestations including gastrointestinal symptoms (87.3%) and cardiovascular involvement (55.3% myocardial dysfunction, 21.7% coronary artery aneurysms, 65.8% shock).
- Elevated inflammatory and cardiac markers were noted. Treatments included intravenous immunoglobulin, aspirin, and corticosteroids.
- While 55.1% showed improved myocardial dysfunction at discharge, the mortality rate was 1.9% and extracorporeal membrane oxygenation was used in 6.3% of cases.
Conclusions:
- MIS-C frequently involves multiple organ systems, particularly the gastrointestinal and cardiovascular systems.
- The clinical presentation of MIS-C appears distinct from Kawasaki disease.
- MIS-C can lead to severe complications including organ failure, necessitating prompt recognition and management.
Background:
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 has been increasingly recognized. However, the clinical features of MIS-C and the differences from Kawasaki disease remain unknown. The study aims to investigate the epidemiology and clinical course of MIS-C.
Methods:
PubMed and EMBASE were searched through August 30, 2020. Observational studies describing MIS-C were included. Data regarding demographic features, clinical symptoms, laboratory, echocardiography and radiology findings, treatments, and outcomes were extracted. Study-specific estimates were combined using one-group meta-analysis in a random-effects model.
Results:
A total of 27 studies were identified including 917 MIS-C patients. The mean age was 9.3 (95% confidence interval [CI], 8.4-10.1). The pooled proportions of Hispanic and Black cases were 34.6% (95% CI, 28.3-40.9) and 31.5% (95% CI, 24.8-38.1), respectively. The common manifestations were gastrointestinal symptoms (87.3%; 95% CI, 82.9-91.6) and cardiovascular involvement such as myocardial dysfunction (55.3%; 95% CI, 42.4-68.2), coronary artery aneurysms (21.7%; 95% CI, 12.8-30.1) and shock (65.8%; 95% CI, 51.1-80.4), with marked elevated inflammatory and cardiac markers. The majority of patients received intravenous immunoglobulin (81.0%; 95% CI, 75.0-86.9), aspirin (67.3%; 95% CI, 48.8-85.7), and corticosteroids (63.6%; 95% CI, 53.4-73.8) with a variety of anti-inflammatory agents. Although myocardial dysfunction improved in 55.1% (95% CI, 33.4-76.8) at discharge, the rate of extracorporeal membrane oxygenation use was 6.3% (95% CI, 2.8-9.8) and the mortality was 1.9% (95% CI, 1.0-2.8).
Conclusion:
Our findings suggest that MIS-C leads to multiple organ failure, including gastrointestinal manifestations, myocardial dysfunction and coronary abnormalities, and has distinct features from Kawasaki disease.
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