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Longitudinal Outcomes for Multisystem Inflammatory Syndrome in Children
Kanwal M Farooqi1, Angela Chan2, Rachel J Weller3
1Divisions of Pediatric Cardiology kf2549@cumc.columbia.edu.
Insights
Most children with multisystem inflammatory syndrome in children (MIS-C) recover rapidly from critical illness, with most inflammatory and cardiac issues resolving within months. Persistent T-cell abnormalities were noted in some patients.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Immunology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) emerged in spring 2020, linked to SARS-CoV-2.
- The long-term effects of MIS-C on children are not well understood.
- This study investigates longitudinal outcomes of MIS-C patients.
Purpose of the Study:
- To describe the longitudinal outcomes of children diagnosed with MIS-C.
- To assess the resolution of inflammatory and cardiac manifestations.
- To identify any persistent immunological changes post-MIS-C.
Main Methods:
- A cohort of children under 21 admitted with MIS-C in 2020 was followed.
- Follow-up assessments occurred at 1-4 weeks, 1-4 months, and 4-9 months post-discharge.
- Data collected included clinical status, inflammatory markers, and echocardiographic findings.
Main Results:
- Most of the 45 MIS-C patients required intensive care and cardiovascular support.
- Elevated inflammatory markers and significant echocardiographic abnormalities, including coronary issues, were common on admission.
- While most markers normalized by 1-4 weeks, persistent lymphocytosis and elevated double-negative T cells were observed, with most cardiac findings resolving by 1-4 weeks.
Conclusions:
- The majority of critically ill children with MIS-C experienced rapid resolution of inflammatory and cardiac symptoms.
- Longitudinal follow-up revealed a high rate of persistent T-cell alterations.
- Overall, MIS-C outcomes were favorable, with most children recovering well over time.
Background:
In spring 2020, a novel hyperinflammatory process associated with severe acute respiratory syndrome coronavirus 2 multisystem inflammatory syndrome in children (MIS-C) was described. The long-term impact remains unknown. We report longitudinal outcomes from a New York interdisciplinary follow-up program.
Methods:
All children <21 years of age, admitted to NewYork-Presbyterian with MIS-C in 2020, were included. Children were followed at 1 to 4 weeks, 1 to 4 months, and 4 to 9 months postdischarge.
Results:
In total, 45 children were admitted with MIS-C. The median time to last follow-up was 5.8 months (interquartile range 1.3-6.7). Of those admitted, 76% required intensive care and 64% required vasopressors and/or inotropes. On admission, patients exhibited significant nonspecific inflammation, generalized lymphopenia, and thrombocytopenia. Soluble interleukin (IL) IL-2R, IL-6, IL-10, IL-17, IL-18, and C-X-C Motif Chemokine Ligand 9 were elevated. A total of 80% (n = 36) had at least mild and 44% (n = 20) had moderate-severe echocardiographic abnormalities including coronary abnormalities (9% had a z score of 2-2.5; 7% had a z score > 2.5). Whereas most inflammatory markers normalized by 1 to 4 weeks, 32% (n = 11 of 34) exhibited persistent lymphocytosis, with increased double-negative T cells in 96% of assessed patients (n = 23 of 24). By 1 to 4 weeks, only 18% (n = 7 of 39) had mild echocardiographic findings; all had normal coronaries. At 1 to 4 months, the proportion of double-negative T cells remained elevated in 92% (median 9%). At 4 to 9 months, only 1 child had persistent mild dysfunction. One had mild mitral and/or tricuspid regurgitation.
Conclusions:
Although the majority of children with MIS-C present critically ill, most inflammatory and cardiac manifestations in our cohort resolved rapidly.
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