Cardiac markers of multisystem inflammatory syndrome in children (MIS-C) in COVID-19 patients: A meta-analysis

Abstract

Objective A meta-analysis of laboratory cardiac markers for multisystem inflammatory syndrome in children (MIS-C) was performed in patients with coronavirus disease 2019 (COVID-19). Methods Eight databases were searched until April 10, 2021, for studies on cardiac markers, including B-type natriuretic peptide (BNP)/N-terminal pro-BNP (NT-proBNP), troponin, aspartate aminotransferase (AST), in MIS-C patients. Results Of the 2583 participants enrolled in 24 studies, 1613 patients were diagnosed with MIS-C. MIS-C patients exhibited higher BNP levels than patients with non-severe COVID-19 [SMD ( 95% CI ): 1.13 (0.48, 1.77), p < 0.05]. No significant differences in BNP levels were observed between patients with MIS-C and severe COVID-19 [SMD ( 95% CI ): 0.29 (−0.07, 0.65), p = 0.117]. Comparisons of MIS-C patients to all COVID-19 patients revealed no significant differences in levels of troponin [SMD ( 95% CI ): 0.13 (−0.07, 0.32), p = 0.212] or AST [SMD ( 95% CI ): 0.10 (−0.11, 0.31), p = 0.336]. Compared to patients with non-severe MIS-C, those with severe MIS-C exhibited higher levels of BNP [SMD ( 95% CI ): 0.26 (0.04, 0.48), p < 0.05], but no differences in troponin [SMD ( 95% CI ): 0.05 (−0.06, 0.16) p = 0.387] or AST [SMD ( 95% CI ): 0.19 (−0.34, 0.71), p = 0.483] were observed. Moreover, there was no significant difference in BNP [SMD ( 95% CI ): −0.21 (−1.07, 0.64), p = 0.624] or troponin [SMD ( 95% CI ): −0.07 (−0.45, 0.31), p = 0.710] between MIS-C with and without coronary artery abnormality. Sensitivity analyses were performed to assess stability. No publication bias was detected based on Begg's test. Conclusions The key cardiac marker that showed differences between patients with MIS-C/non-severe COVID-19 and between patients with severe/non-severe MIS-C was BNP. Other markers, such as troponin and AST, did not exhibit notable differences in indicating cardiac injury between patients with MIS-C and COVID-19.

A comparative study of IL‐6, CRP and NT‐proBNP levels in post‐COVID multisystem inflammatory syndrome in children (MISC) and Kawasaki disease patients

“…A meta-analysis also showed that the key cardiac marker in patients with MISC was BNP. 13 Although previously alluded to, 14,15 statistical analysis in this study conclusively shows that NT-proBNP and CRP levels are significantly higher among MISC patients in comparison to KD with elevation of these parameters; >935.7 and >99.55 mg/L at admission respectively might act as guides as to the need for more aggressive management.…”

COVID-19 in children and adolescents: MIS(-C)-taken diagnoses

“…Our findings in non-MIS-C patients confirm previous findings that NT-proBNP is also elevated in systemic inflammation and might not only have a cardiac source [16]. A recent meta-analysis has shown higher BNP levels in MIS-C patients vs. non-severe COVID-19 infections and in patients with severe MIS-C vs. non-severe MIS-C. Abnormal levels did not correlate with direct coronary artery lesions; however, cardiac markers may be monitored longitudinally in admitted MIS-C patients to predict potential deterioration during the disease course [17].…”

Das Pädiatrische Inflammatorische Multisystem Syndrom (PIMS) in der COVID-19 Pandemie

“…Eine weitere Metaanalyse kommt zum Schluss, dass Patienten mit schwerem PIMS/MIS-C höhere Werte für pro-BNP im Vergleich zu Patienten mit milder COVID-19 Erkrankung und Patienten mit leichtem PIMS/MIS-C aufwiesen; für Troponin und ASAT ergaben sich hingegen keine Unterschiede zwischen diesen Patientengruppen. Interessanterweise waren die proBNP-und Troponinwerte bei Patienten mit PIMS/MIS-C mit und ohne Beteiligung der Koronararterien nicht signifikant verschieden [17].…”