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Long-Term Outcomes of Multisystem Inflammatory Syndrome in Children up to 4.5 Years After COVID-19
Shiv Mehrotra-Varma1, Hien Quang Nguyen1, Sonya Henry1
1Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York.
Insights
Multisystem inflammatory syndrome in children (MIS-C) following COVID-19 leads to long-term health issues affecting multiple organ systems. These persistent complications underscore the need for ongoing medical monitoring and care for affected children.
Area of Science:
- Pediatric infectious diseases
- Post-viral syndromes
- Public health
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a severe post-COVID-19 complication.
- The long-term health consequences of MIS-C are not well understood.
Purpose of the Study:
- To investigate the long-term risks of multisystem dysfunction in children with MIS-C compared to those without.
- To identify factors influencing persistent morbidity after MIS-C.
Main Methods:
- A retrospective cohort study involving 173 children with MIS-C and 14,190 controls up to 4.5 years post-COVID-19.
- Propensity score matching and Cox regression analysis were used to compare outcomes.
- Outcomes included cardiovascular, gastrointestinal, respiratory, neurological, and renal disorders.
Main Results:
- Patients with MIS-C had significantly higher risks of cardiovascular, hypertension, gastrointestinal, respiratory, and neurological disorders.
- Preexisting hypertension, age, and diabetes were associated with increased risks of specific complications.
- Kaplan-Meier analysis revealed persistent risks for all evaluated outcomes in the MIS-C group.
Conclusions:
- MIS-C is linked to widespread and persistent multisystem morbidity years after acute COVID-19.
- Structured long-term follow-up, including monitoring of blood pressure, neurological, cardiovascular, and renal health, is crucial.
- Coordinated multidisciplinary care is recommended for children with a history of MIS-C.
Objectives:
The risk of persistent multisystem dysfunction following multisystem inflammatory syndrome in children (MIS-C), a severe postviral complication of COVID-19, remains unknown.
Methods:
We investigated long-term outcomes in patients younger than 21 years with MIS-C (n = 173) vs without MIS-C (n = 14 190) up to 4.5 years after COVID-19 in the Montefiore Health System (March 2020 to August 2024). MIS-C status was based on International Classification of Diseases, Tenth Revision codes and Centers for Disease Control and Prevention and World Health Organization criteria. 1:2 propensity score matching and Cox proportional hazards regression with multivariable adjustment were performed.
Results:
Compared with patients without, patients with MIS-C showed markedly higher risk of cardiovascular disorders (adjusted hazard ratio [aHR] = 13.88 [4.69-41.07], P < .001), hypertension (aHR = 8.86 [4.12-19.06], P < .001), gastrointestinal disorders (aHR = 9.48 [2.66-33.71], P < .001), respiratory disorders (aHR = 3.46 [2.21-5.42], P < .001), and neurological disorders (aHR = 2.02 [1.22-3.34], P = .007). Preexisting hypertension (9.25% of patients with MIS-C vs 6.94% of controls) significantly predicted cardiovascular, neurological, respiratory, and gastrointestinal outcomes. Each 1-year increase in age was associated with increased risk of shock (aHR = 1.06 [1.02-1.11]) and chronic kidney disease (CKD) (aHR = 1.06 [1.01-1.12]). Preexisting diabetes (1.73% of patients with MIS-C) was associated with a 49-fold increased risk of CKD. Kaplan-Meier analysis showed higher persistent risk in the MIS-C group across all outcomes, ranging from 6.8% for CKD to 35.2% for respiratory disorders. Sensitivity analysis using different definitions of MIS-C corroborated our main findings.
Conclusions:
MIS-C is associated with broad multisystem morbidity persisting years after acute COVID-19, challenging earlier reports of transient illness. Structured long-term follow-up, including routine blood pressure monitoring, neurological and mental-health screening, and cardiovascular and renal surveillance, with coordinated multidisciplinary care is warranted.
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