Characteristics and outcomes of multisystem inflammatory syndrome in children: A multicenter, retrospective, observational cohort study in Mexico

Abstract

IntroductionMultisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death.MethodsThis multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression.ResultsThe study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4–2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8–31.0), platelet count <150,000 /mm3 (OR: 4.2, 95% CI: 1.2–14.7), international normalized ratio >1.2 (OR: 3.8, 95% CI: 1.05–13.9), and serum ferritin concentration >1,500 mg/dl at admission (OR: 52, 95% CI: 5.9–463) were risk factors for death.DiscussionMortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases.

Knowledge framework of intravenous immunoglobulin resistance in the field of Kawasaki disease: A bibliometric analysis (1997−2023)

“…From 2009 to 2018, the annual number of publications gradually increased, indicating that more scholars were paying attention to the importance of IVIG resistance research. From 2019 to 2022, the number of publications increased significantly, which may have been due to the COVID‐19 pandemic, when a large number of children had KD‐like symptoms 26,27 . What is more, we noticed a rapid increase in the number of publications and citations in 2019, during which a phase III clinical trial in Japan confirmed that initial treatment with IVIG and cyclosporine (CSA) improved the prognosis of coronary artery injury 28 …”

Resurgence of influenza A after SARS-CoV-2 omicron wave and comparative analysis of hospitalized children with COVID-19 and influenza A virus infection

“…Diagnostic criteria for benign acute childhood myositis was children presenting with sudden gait-related abnormalities or refusal to bear weight after a viral illness, neurologic findings are usually normal and creatinine kinase level is elevated, with conservative treatment measures, the condition usually resolves spontaneously within a week and without residual sequelae ( 12 ). Patient files were reviewed to identify cases of multisystem inflammatory syndrome in children (MIS-C) based on relevant literature references ( 13 , 14 ).…”

COVID-19 among infants: key clinical features and remaining controversies

“…Another study found no difference in mortality between nonsevere (0%) versus severe (0.96%) disease among infants admitted to the hospital.10) Comorbidities may be associated with mortality, but it must also be considered that, in the face of congenital anomalies and other significant comorbidities, the cause of death may not always be truly ascribed to SARS-CoV-2 [ 23 , 32 , 111 ]. Deaths among children with MIS-C or MIS-N presentations have been published [ 9 , 46 , 49 , 112 , 113 ].…”

“…23,32,111) Deaths among children with MIS-C or MIS-N presentations have been published. 9,46,49,112,113) Autopsy studies of deceased infants are meager, and most accumulation of COVID-19-related autopsy information stems from the findings among deceased adults. 114,115) Reviews for pediatric autopsy tend to focus on older children, and the proportionate number of infants aged <1 year has been <50%.…”