One- and Two-year Multidisciplinary Follow-Up of MIS-C at a Tertiary Hospital: A Retrospective Cohort Study
Sarah May Johnson1, Justin Penner1, Richard Issitt2,3
1From theDepartment of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom.
Insights
Multisystem inflammatory syndrome in children (MIS-C) patients show sustained recovery up to two years, with rare chronic fatigue and neurological issues. Variant changes did not impact clinical severity or outcomes, offering reassurance for long-term health.
Area of Science:
- Pediatric Infectious Diseases
- Inflammatory Syndromes
- Public Health
Background:
- Limited data exists on long-term sequelae of multisystem inflammatory syndrome in children (MIS-C).
- The impact of evolving SARS-CoV-2 variants on MIS-C severity and outcomes requires further investigation.
- Previous 6-month follow-up data for MIS-C was reassuring, but long-term data is scarce.
Purpose of the Study:
- To evaluate long-term sequelae in children diagnosed with MIS-C.
- To assess if changing SARS-CoV-2 variants influenced MIS-C clinical severity and patient outcomes.
- To track recovery patterns and identify persistent symptoms in MIS-C patients over a 2-year period.
Main Methods:
- Retrospective cohort study of children (<18 years) diagnosed with MIS-C at Great Ormond Street Hospital (April 2020 - January 2023).
- Data categorized by predominant circulating SARS-CoV-2 variants in the UK during admission and follow-up periods.
- Analysis of clinical data, inflammatory markers, and patient-reported symptoms at various follow-up intervals (6 months, 1 year, 2 years).
Main Results:
- 160 children with MIS-C were included; no significant differences in time to diagnosis or hospitalization days were observed across different SARS-CoV-2 variant waves.
- Inflammatory markers normalized within 2 years for most patients. Persistent symptoms at 2 years included abdominal pain (n=5) and myalgia (n=2).
- Chronic fatigue or long-COVID symptoms were rare (n=1), and all patients demonstrated sustained neurological recovery, irrespective of concurrent Epstein-Barr virus positivity.
Conclusions:
- Patients with MIS-C generally experience sustained recovery, indicating positive long-term outcomes.
- Clinical severity, time to diagnosis, and length of stay remained consistent across different SARS-CoV-2 variant waves.
- Distinguishing MIS-C symptomatology from long-COVID is crucial for effective, individualized treatment plans.
Background:
Although 6-month follow-up of patients with multisystem inflammatory syndrome in children (MIS-C) was reassuring, there is scant data on long-term sequelae, including whether changing variants affect clinical severity and outcomes.
Methods:
Children (<18 years of age) admitted to Great Ormond Street Hospital between April 4, 2020, and January 2023, meeting diagnostic criteria for MIS-C were included. Admission and follow-up data were categorized by the predominant SARS-CoV-2 circulating variant in the United Kingdom.
Results:
One hundred and sixty children [median age, 10.1 (interquartile range, 7.9-12.6) years] were included. There was no difference in the time of symptom onset to diagnosis between waves ( P =0.23) or hospitalization days across all waves ( P =0.32). Inflammatory markers were normal for up to 2 years in all patients except one. Eleven patients (6.9%) remain in follow-up: cardiology (n=5), gastroenterology (n=5) and nephrology (n=1). The main self-reported symptoms at 2 years were abdominal pain (n=5) and myalgia (n=2). Fatigue was present in approximately a quarter of patients at admission; this reduced to 14 (9%), (2%) and 1 (2%) at 6-month, 1-year and 2-year follow-ups, respectively. Chronic fatigue or long-COVID symptomatology was rare (n=1) even with high rates of concurrent Epstein-Barr virus positivity (49/134). All patients had sustained neurological recovery with no new neurological pathology observed.
Conclusions:
Patients with MIS-C have a sustained recovery, which is reassuring for positive long-term outcomes. Across waves, time from symptom onset to diagnosis and treatment, symptomatology and length of stay were similar. Sustained recovery is reassuring for clinicians and parents alike. Differentiating long-COVID symptomatology from that of MIS-C is important in formulating an individualized treatment plan.
