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Multisystem inflammatory syndrome in 1.2 million children: longitudinal cohort study of risk factors
Nathalie Auger1,2,3,4, Gabriel Côté-Corriveau5,6,7, Harb Kang8
1Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada. nathalie.auger@inspq.qc.ca.
Insights
Children with prior metabolic disorders, atopic conditions, or cancer face a significantly higher risk of developing multisystem inflammatory syndrome (MIS-C). Maternal and birth factors did not influence MIS-C risk in this large pediatric study.
Area of Science:
- Pediatric Health
- Infectious Disease Epidemiology
- Immunology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication of COVID-19.
- Identifying risk factors for MIS-C is crucial for early recognition and management.
- Previous studies have not clearly defined the pediatric morbidities predisposing children to MIS-C.
Purpose of the Study:
- To identify patient characteristics associated with an increased risk of developing MIS-C.
- To investigate the association between prepandemic morbidities and MIS-C, Kawasaki disease, and other COVID-19 complications.
- To determine the role of birth outcomes and maternal history in MIS-C development.
Main Methods:
- A longitudinal cohort study of 1,195,327 children aged 0-19 years was conducted between 2006 and 2021.
- Data included prepandemic morbidity, birth outcomes, family history, and COVID-19 related outcomes during the pandemic.
- Log-binomial regression models were used to calculate risk ratios (RRs) and 95% confidence intervals (CIs) for associations.
Main Results:
- Prepandemic hospitalizations for metabolic disorders (RR 11.3), atopic conditions (RR 3.34), and cancer (RR 8.11) were strongly associated with increased MIS-C risk.
- These prepandemic conditions also correlated with Kawasaki disease and other COVID-19 complications.
- Birth characteristics and maternal morbidity history showed no association with MIS-C development.
Conclusions:
- Children with pre-existing pediatric morbidities, specifically metabolic disorders, atopic conditions, and cancer, have a substantially elevated risk of MIS-C.
- Pediatric morbidities appear to be more significant predictors of MIS-C than maternal or perinatal factors.
- These findings can aid clinicians in identifying high-risk children for MIS-C.
Background:
We identified patient characteristics associated with an increased risk of developing MIS-C.
Methods:
We conducted a longitudinal cohort study of 1,195,327 patients aged 0-19 years between 2006 and 2021, including the first two waves of the pandemic (February 25-August 22, 2020 and August 23, 2020-March 31, 2021). Exposures included prepandemic morbidity, birth outcomes, and family history of maternal disorders. Outcomes included MIS-C, Kawasaki disease, and other Covid-19 complications during the pandemic. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for the association between patient exposures and these outcomes using log-binomial regression models adjusted for potential confounders.
Results:
Among 1,195,327 children, 84 developed MIS-C, 107 Kawasaki disease, and 330 other Covid-19 complications during the first year of the pandemic. Prepandemic hospitalizations for metabolic disorders (RR 11.3, 95% CI 5.61-22.6), atopic conditions (RR 3.34, 95% CI 1.60-6.97), and cancer (RR 8.11, 95% CI 1.13-58.3) were strongly associated with the risk of MIS-C, compared with no exposure. These same exposures were also associated with Kawasaki disease and other Covid-19 complications. However, birth characteristics and history of maternal morbidity were not associated with MIS-C development.
Conclusions:
Children with pre-existing morbidity have a considerably elevated risk of MIS-C.
Impact:
Morbidities that predispose children to multisystem inflammatory syndrome (MIS-C) are unclear. In this study, prepandemic hospitalizations for metabolic disorders, atopic conditions, and cancer were associated with an elevated risk of MIS-C. Birth characteristics and family history of maternal morbidity were not, however, associated with MIS-C. Pediatric morbidities may play a greater role in MIS-C onset than maternal or perinatal characteristics, and may help clinicians better recognize children at risk for this complication.
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