Spectrum of severity of multisystem inflammatory syndrome in children: An EHR-based cohort study from the RECOVER program
Rao, S; Jing, N; Liu, X; et al., Scientific Reports
Published
November 2023
Journal
Scientific Reports
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.
Authors
Suchitra Rao, Naimin Jing, Xiaokang Liu, Vitaly Lorman, Mitchell Maltenfort, Julia Schuchard, Qiong Wu, Jiayi Tong, Hanieh Razzaghi, Asuncion Mejias, Grace M Lee, Nathan M Pajor, Grant S Schulert, Deepika Thacker, Ravi Jhaveri, Dimitri A Christakis, L Charles Bailey, Christopher B Forrest, Yong Chen
Keywords
Humans; Child; Cohort Studies; Retrospective Studies; Systemic Inflammatory Response Syndrome/diagnosis/epidemiology; Connective Tissue Diseases
Short Summary
RECOVER researchers studied how multisystem inflammatory syndrome (MIS-C) looks different in a large group of children. The researchers looked at electronic health record (EHR) data from 8 children’s hospitals from March 2020 to September 2022. They studied 1,139 children who were patients hospitalized for MIS-C. The researchers divided the patients into 3 groups and used age, sex, location, symptoms, conditions, test results, and medications to look for patterns in these groups. Researchers then looked at how the groups were similar and how they changed over time. The study showed that MIS-C has a range of severity, from mild to medium and severe. This means that MIS-C symptoms can be different for each child. The researchers also found that there are fewer severe MIS-C cases now than there used to be. The study might not have included some children if they had symptoms like MIS-C but had a different illness, had Kawasaki disease when they were in the hospital (because of how similar the symptoms can be to MIS-C), or had mild MIS-C symptoms that did not bother them that much and may not have been written in their EHR. This study can help doctors better understand and treat MIS-C.