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Spectrum of severity of multisystem inflammatory syndrome in children: an EHR-based cohort study from the RECOVER
Suchitra Rao1, Naimin Jing2,3, Xiaokang Liu2
1Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, 13123 E 16th Ave Box 090, Aurora, CO, 80045, USA. suchitra.rao@childrenscolorado.org.
Insights
Multi-system inflammatory syndrome in children (MIS-C) presents a spectrum of severity, from mild to critical. Researchers identified three distinct clinical patterns, with severe cases decreasing over time.
Area of Science:
- Pediatric infectious diseases
- Immunology
- Public health
Background:
- Multi-system inflammatory syndrome in children (MIS-C) is a serious condition following SARS-CoV-2 infection.
- Understanding MIS-C's diverse presentations is crucial for effective management.
- Previous studies highlight heterogeneity in MIS-C's clinical manifestations.
Purpose of the Study:
- To characterize the clinical spectrum of MIS-C.
- To identify distinct patient subgroups within MIS-C.
- To inform improved recognition and management strategies for MIS-C.
Main Methods:
- Retrospective cohort study of 1139 children hospitalized with MIS-C.
- Data collected from March 2020 to September 2022 across 8 pediatric centers.
- Heterogeneity-adaptive latent class analysis used to identify disease patterns.
Main Results:
- Three distinct latent classes of MIS-C were identified, representing mild, moderate, and severe presentations.
- Class 1 (47.9%) showed severe illness with ICU admission, shock, cardiac, kidney, and respiratory involvement.
- Class 2 (23.3%) had moderate illness with 4-6 organ systems involved; Class 3 (28.8%) had mild illness. The proportion of severe MIS-C decreased over time.
Conclusions:
- MIS-C exhibits a significant spectrum of clinical severity.
- Identification of distinct MIS-C classes aids in tailored patient management.
- The declining trend in severe MIS-C cases warrants further investigation.
Abstract:
Multi-system inflammatory syndrome in children (MIS-C) is a severe post-acute sequela of SARS-CoV-2 infection in children, and there is a critical need to unfold its highly heterogeneous disease patterns. Our objective was to characterize the illness spectrum of MIS-C for improved recognition and management. We conducted a retrospective cohort study using data from March 1, 2020-September 30, 2022, in 8 pediatric medical centers from PEDSnet. We included 1139 children hospitalized with MIS-C and used their demographics, symptoms, conditions, laboratory values, and medications for analyses. We applied heterogeneity-adaptive latent class analyses and identified three latent classes. We further characterized the sociodemographic and clinical characteristics of the latent classes and evaluated their temporal patterns. Class 1 (47.9%) represented children with the most severe presentation, with more admission to the ICU, higher inflammatory markers, hypotension/shock/dehydration, cardiac involvement, acute kidney injury and respiratory involvement. Class 2 (23.3%) represented a moderate presentation, with 4-6 organ systems involved, and some overlapping features with acute COVID-19. Class 3 (28.8%) represented a mild presentation. Our results indicated that MIS-C has a spectrum of clinical severity ranging from mild to severe and the proportion of severe or critical MIS-C decreased over time.
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