Short to midterm follow-up of multi-system inflammatory syndrome in children with special reference to cardiac
Omeir A Aziz1, Masood Sadiq1, Ahmad U Qureshi1
1Department of Paediatric Cardiology, The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan.
Insights
Children with multi-system inflammatory syndrome (MIS-C) show good early recovery, but MIS-C with shock is dangerous. Midterm follow-up reveals normal heart function and recovery in most coronary artery issues.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multi-system inflammatory syndrome in children (MIS-C) is a serious post-COVID complication.
- Cardiac involvement is a significant concern in pediatric MIS-C cases.
- Understanding the long-term cardiac outcomes is crucial for patient management.
Purpose of the Study:
- To describe the early and up to 16-month follow-up of MIS-C in children.
- To specifically analyze cardiac involvement and its progression in MIS-C patients.
- To identify risk factors and outcomes, particularly in MIS-C with shock.
Main Methods:
- A cohort, non-interventional descriptive study included pediatric patients (<18 years) admitted between May 2020 and April 2021.
- Patients were classified into three groups: MIS-C with overlapping Kawasaki Disease, MIS-C without overlapping Kawasaki Disease, and MIS-C with shock.
- Follow-up assessments were conducted at 1, 3, 6, 12, and 16 months post-discharge.
Main Results:
- Forty-one patients met WHO criteria for MIS-C, with 36.5% exhibiting cardiac involvement.
- Early cardiac issues included impaired LV function (12.2%), coronary artery involvement (24.4%), and pericardial effusion (14.6%).
- Two hospital deaths (4.9%) occurred, exclusively in the MIS-C with shock subgroup (20%).
- By 6 months, LV function normalized in all patients, and 80% showed recovery from coronary abnormalities by last follow-up (median 9.8 months).
Conclusions:
- Children with MIS-C generally have favorable early outcomes.
- MIS-C with shock presents a life-threatening condition, especially in resource-limited settings.
- Midterm follow-up demonstrates complete LV function normalization and significant recovery from coronary abnormalities in most MIS-C patients.
Objectives:
We aim to describe the early and upto 16 months follow-up of post-coronavirus disease (COVID), multi-system inflammatory syndrome in children (MIS-C), with special reference to cardiac involvement.
Study Design:
This cohort non-interventional descriptive study included patients <18 years admitted between May, 2020 and April, 2021. Based on underlying similarities, children were classified as post-COVID MIS-C with overlapping Kawasaki Disease, MIS-C with no overlapping Kawasaki Disease, and MIS-C with shock. Post-discharge, patients were followed at 1, 3, 6, 12, and 16 months.
Results:
Forty-one patients predominantly males (73%), at median age of 7 years (range 0.2-16 years) fulfilled the World Health Organisation criteria for MIS-C. Cardiac involvement was seen in 15 (36.5%); impaired left ventricle (LV) function in 5 (12.2%), coronary artery involvement in 10 (24.4%), pericardial effusion in 6 (14.6%) patients, and no arrhythmias. There were two hospital deaths (4.9%), both in MIS-C shock subgroup (2/10, 20%). At 1 month, there was persistent LV dysfunction in 2/5, coronary artery abnormalities in 7/10, and pericardial effusion resolved completely in all patients. By 6 months, LV function returned to normal in all but coronary abnormalities persisted in two patients. At last follow-up (median 9.8 months, interquartile range 2-16 months), in 36/38 (94.7%) patients, coronary artery dilatation was persistent in 2 (20%) patients.
Conclusions:
Children with MIS-C have a good early outcome, though MIS-C with shock can be life-threatening subgroup in a resource-constrained country setting. On midterm follow-up, there is normalisation of LV function in all and recovery of coronary abnormalities in 80% of patients.
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