Cardiac manifestations in children with the multisystem inflammatory syndrome (MIS‐C) associated with SARS‐CoV‐2 infection: Systematic review and meta‐analysis

Abstract

According to the World Health Organisation, as of October 2022, there have been 55,560,329 reported cases of SARS‐COV‐2 in patients under 19 years old. It is estimated that about 0.06% of these patients may develop MIS‐C, representing more than 2 million children worldwide. This systematic review and meta‐analysis examined the pooled prevalence of cardiovascular manifestation and cardiac complications in children hospitalised with MIS‐C. The PROSPERO register number is CRD42022327212. We included case‐report studies, case‐control studies, cohort studies, and cross‐sectional studies, as well as clinical trials or studies describing cardiac manifestations of MIS‐C and its sequelae in a paediatric population. Initially, 285 studies were selected, but there were 154 duplicates, and 81 were excluded because they did not fit the eligibility criteria. Thus, 50 studies were selected for review, and 30 were included in the meta‐analysis. A total sample size of 1445 children was included. The combined prevalence of myocarditis or pericarditis was 34.3% (95% CI: 25.0%–44.2%). The combined prevalence for echocardiogram anomalies was 40.8% (95% CI: 30.5%–51.5%), that of Kawasaki disease presentation was 14.8% (95% CI: 7.5%–23.7%), and that of coronary dilation was 15.2% (95% CI: 11.0%–19.8%). The rate of electrocardiogram anomalies was 5.3% (95% CI: 0.8%–12.3%), and the mortality rate was 0.5% (CI 95%: 0%–1.2%). Furthermore, 186 children still had complications at discharge, with a combined prevalence of such long‐lasting manifestations of 9.3% (95% CI: 5.6%–13.7%). Studies that assess whether these children will have an increased cardiovascular risk with a greater chance of acute myocardial infarction, arrhythmias, or thrombosis will be essential for healthcare planning.

Incidence and Prevalence of Multisystem Inflammatory Syndrome in Children (MIS-C) in Southern Italy

“…Regarding the sex ratio, according to previously published data, a higher prevalence was also found in males (63.63%). The median age of our cohort was 7.54 years, in the lower end of the reported range (7.3-10.8 years) for MIS-C [4,19,37], although this was older compared to the published range for Kawasaki Disease, which is mainly shown to affect children aged less than 5 years [1,2]. Moreover, in our study, about 1 in every 1400 children who had contracted COVID-19 was at risk of developing MIS-C.…”

“…In fact, gastrointestinal symptoms such as abdominal pain, vomiting, and diarrhea are the predominant clinical manifestation in MIS-C patients and were found in 70-90% of cases [6,[9][10][11][12][13][14][15][16][17][18]. Cardiac involvement was found in 35-80% of patients, and the combined prevalence of myocarditis or pericarditis was 34.3% [6,9,19]. The incidence of coronary artery dilatation varied between 10% and 48% in different reports [15,20,21].…”

Association of Low Levels of Soluble Low-Density Lipoprotein Receptor-Related Protein-1 and COVID-19 Outcomes During the First Wave of Pandemic

“…The patients were from the ED, IS, and ICU. The factors that are affecting the clinical outcome in adults and pediatric age groups differ in COVID-19 [ 26 , 27 ]. The mortality is high in the much older population (≥80 years) during the first wave [27}.…”

“…The mortality is high in the much older population (≥80 years) during the first wave [27}. Further research is required to study the differences between younger and much older populations [ 26 , 27 ]. This is a cross-sectional study with a limited number of cases.…”

Life‐threatening severe acute respiratory syndrome coronavirus‐2 mRNA vaccine‐associated myocarditis after COVID‐19 myocarditis

“…Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection, also known as coronavirus disease 2019 (COVID‐19), can cause myocarditis. However, the incidence of myocarditis was reported to be less than 0.1% among children with SARS‐CoV‐2 infection 1 . Myocarditis is also known as one of the side effects of SARS‐CoV‐2 mRNA vaccination, especially in males, and it occurs more frequently in young adults and older children 2 .…”