Multisystem inflammatory syndrome (MIS-C): a systematic review and meta-analysis of clinical characteristics, treatment, and outcomes

Santos, Mônica Oliveira; Gonçalves, Lucas Cândido; Silva, Paulo A.N.; Moreira, André; Ito, Célia Regina Malveste; Peixoto, Fernanda A.O.; Wastowski, Isabela Jubé; Carneiro, Lí­lian Carla; Avelino, Melissa Ameloti Gomes

doi:10.1016/j.jped.2021.08.006

Cited by 63 publications

(44 citation statements)

References 112 publications

(167 reference statements)

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“…A previous meta-analysis reported that 58% (55-61%) of children with MIS-C were male and their median age was 8.9 years [15]. In our patient population, on the other hand, female gender was predominant (61%) while their mean age was similar to the gures reported in the literature [8.8 ± 4.4 years (range 1.8 -17.8 years)].…”

Section: Discussionsupporting

confidence: 84%

Late-Term Cardiac Magnetic Resonance Imaging in Multisystem Inflammatory Syndrome in Children

Argun

Seber

Durmuş

et al. 2022

Preprint

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Multisystem inflammatory syndrome in children (MIS-C) develops as an exaggerated, complex, postinfectious immune response related to severe acute respiratory syndrome coronavirus (SARS-CoV-2 virus), which affects all systems in the body. Cardiac involvement in children can have a spectrum ranging from mild disease to severe heart failure due to fulminant myocarditis. Cardiac involvement usually resolves after clinical recovery. However, the adverse effect of myocarditis on cardiac function after recovery is not fully known. In this study, we aimed to investigate cardiac involvement by performing cardiac magnetic resonance imaging (MRI) after acute and recovery stage. Here, we describe the clinical and laboratory features and the effect of treatment on the development of fibrosis on cardiac MRI in 21 patients with MIS-C and the localization of fibrosis in five patients.When compared with 16 patients with normal cardiac MRI, five patients with cardiac fibrosis on MRI had a greater age (mean 14.4 ± 4.0 years vs 8.9 ± 3.5 years; p=0.007), a similar gender distribution (male/female: 3/2 vs 5/11; p= 0.325), a greater body mass index (BMI) (mean 22.68±4.48 kg/m2 vs 17.73±3.15 kg/m2;p=0.012), a lower leucocyte count, [median 5250/μl (3880-7790) vs 12065/μl (4210-21210); p=0.011], a lower neutrophil count [median 4000/μl (2150-6560) vs 9875/μl (2540-18500); p=0.019], a higher blood urea nitrogen level [median 15 mg/dL (11-26.8) vs 8.5 mg/dL (4-18); p=0.025], and a higher creatinine level (mean 0.61±0.07 mg/dL vs 0.45±0.14 mg/dL; p= 0.024). Cardiac fibrosis on MRI was located in the region of posterior right ventricle insertion point and in the midventricular septum.ConclusionsAdolescence and obesity appear as risk factors for the development of fibrosis as a late-term sequela of myocarditis. We believe that other mechanisms such as a complex immune system response and hemodynamic instability causing acute kidney injury may similarly play a role for the development of cardiac fibrosis. However, this subject should be clarified by more comprehensive studies. Furthermore, future studies reporting the follow-up data of patients with fibrosis are necessary to predict and manage adverse outcomes.

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Section: Discussionsupporting

confidence: 84%

Late-Term Cardiac Magnetic Resonance Imaging in Multisystem Inflammatory Syndrome in Children

Argun

Seber

Durmuş

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…SARS-CoV-2 infection may alter the immunologic system, resulting in states ranging from abnormal cytokine or chemokine production and maladaptive immune response to an increased number of activated macrophages, monocytes, and neutrophils and hyperactivated T cells ( Rodríguez et al, 2020 ). Several studies reported autoimmune diseases such as immune thrombocytopenic purpura (ITP), Guillian-Barrė syndrome (GBS), Graves’ disease, systemic lupus erythematosus (SLE), antiphospholipid antibodies, and thrombosis associated with COVID-19 ( Ehrenfeld et al, 2020 ; Rodríguez et al, 2020 ); however, MIS and autoimmune diseases can occur both para- and post-COVID-19 ( Wang et al, 2015 ; Santos et al, 2021 ). Although the mechanism is unclear, some factors such as pro-inflammatory cytokines and chemokines, damage-associated molecular patterns (DAMPs), molecular mimicry, cross-reactive antibodies, and auto-antibodies may attribute to post-COVID-19 autoimmune diseases ( Liu et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Multisystem Inflammatory Syndrome and Autoimmune Diseases Following COVID-19: Molecular Mechanisms and Therapeutic Opportunities

Hosseini

Fallahi

Erabi

et al. 2022

Front. Mol. Biosci.

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Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), has led to huge concern worldwide. Some SARS-CoV-2 infected patients may experience post–COVID-19 complications such as multisystem inflammatory syndrome, defined by symptoms including fever and elevated inflammatory markers (such as elevation of C reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, procalcitonin test, D-dimer, ferritin, lactate dehydrogenase or IL-6, presence of neutrophilia, lymphopenia, decreased albumin, and multiple organ dysfunction). Post–COVID-19 complications may also manifest as autoimmune diseases such as Guillain-Barré syndrome and systemic lupus erythematosus. Signaling disorders, increased inflammatory cytokines secretion, corticosteroid use to treat COVID-19 patients, or impaired immune responses are suggested causes of autoimmune diseases in these patients. In this review, we discuss the molecular and pathophysiological mechanisms and therapeutic opportunities for multisystem inflammatory syndrome and autoimmune diseases following SARS-CoV-2 infection with the aim to provide a clear view for health care providers and researchers.

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“…Although a meta‐analysis by Behnood et al indicated a lower incidence and severity of acute paediatric COVID‐19, 7 greater attention is now being paid to severe complications following infections in paediatric populations. These include multisystem inflammatory syndrome in children, which is also known as paediatric inflammatory multisystem syndrome temporarily associated with SARS‐CoV‐2 8 …”

Section: Introductionmentioning

confidence: 99%

“…These include multisystem inflammatory syndrome in children, which is also known as paediatric inflammatory multisystem syndrome temporarily associated with SARS‐CoV‐2. 8 This syndrome develops within four weeks of exposure to the SARS‐CoV‐2 virus, regardless of whether COVID‐19 takes a symptomatic or asymptomatic course. It has been associated with a high risk of multiorgan failure, especially with severe cardiac involvement.…”

Section: Introductionmentioning

confidence: 99%

The respiratory consequences of COVID‐19 lasted for a median of 4 months in a cohort of children aged 2–18 years of age

2022

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Aim We focused on the clinical picture, severity and prognosis of children who experienced long‐term respiratory issues after COVID‐19. Methods This was a national Czech multicentre study of paediatric post‐COVID syndrome, which used a standard protocol to evaluate structural and functional anomalies and exclude alternative diagnoses. From 6 January to 30 June 2021, 11 paediatric pulmonologists enrolled all paediatric referrals aged 2–18 years with persistent respiratory symptoms more than 12 weeks after COVID‐19, namely cough, dyspnoea and chest pain. Medical histories were taken, and physical examinations, lung function testing, chest X‐ray and blood tests were performed. Results The dominant symptoms in the 39 children (56.4% girls) were exertional dyspnoea (76.9%) and a chronic cough (48.7%), while dyspnoea at rest (30.8%) and chest pain (17.9%) were less prevalent. More than half (53.8%) reported more than 1 symptom, and 38.5% had abnormal results for 1 of the following tests: lung function, chest X‐ray or D‐dimers. The median age of the children was 13.5 years (interquartile range ±4.8 years), and the median recovery time was 4 months (range 1.5–8 months). Conclusion Our initial data suggest that the long‐term respiratory impact of COVID‐19 was relatively mild in our cohort, with a favourable prognosis.

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Multisystem inflammatory syndrome (MIS-C): a systematic review and meta-analysis of clinical characteristics, treatment, and outcomes

Cited by 63 publications

References 112 publications

Late-Term Cardiac Magnetic Resonance Imaging in Multisystem Inflammatory Syndrome in Children

Late-Term Cardiac Magnetic Resonance Imaging in Multisystem Inflammatory Syndrome in Children

Multisystem Inflammatory Syndrome and Autoimmune Diseases Following COVID-19: Molecular Mechanisms and Therapeutic Opportunities

The respiratory consequences of COVID‐19 lasted for a median of 4 months in a cohort of children aged 2–18 years of age

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