Multisystem Inflammatory Syndrome in Children: Follow-Up of a Cohort from North India

Abstract

Multisystem inflammatory syndrome in children (MIC-S) is a hyperinflammatory manifestation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Information on the long-term outcome of MIS-C is limited. This study was conducted to describe the long-term outcome of MIS-C from a tertiary care center in North India. Children admitted with MIS-C from September 2020 to January 2021 were followed up after discharge until June 2021. The details during the acute phase (clinical features, investigations, treatment, and outcome) and follow-up (symptoms, echocardiographic findings, ongoing treatment, and outcome) were collected retrospectively. During the acute phase, 40 children presented at median (interquartile range [IQR]) age of 7 (5–10) years with fever, mucocutaneous, gastrointestinal, and respiratory symptoms. The majority (66.7%) of the children had positive SARS-CoV-2 serology and elevated inflammatory markers (C-reactive protein, procalcitonin, ferritin, D-dimer, and fibrinogen), lymphopenia, and thrombocytopenia. Eighty percent had shock, 72.5% had myocardial dysfunction (left ventricular ejection fraction <55%), and 22.5% had coronary artery dilatation or aneurysm. Treatment included pediatric intensive care unit admission (85%), intravenous immunoglobulin (100%), steroids (85%), aspirin (80%), vasoactive drugs (72.5%), and invasive mechanical ventilation (22.5%). Two (5%) children died because of refractory shock. Thirty-four children were followed up with until a median (IQR) of 5 (3–6) months. During the follow-up, a majority were asymptomatic, myocardial function returned to normal in all, and only one had coronary artery aneurysm. Prednisolone and aspirin were given for a median (IQR) of 3 (2–4) weeks and 4 (4–6) weeks after discharge, respectively. There was one readmission and no death during the follow-up. To conclude, the long-term outcome of MIS-C is generally favorable with resolution of cardiovascular manifestations (myocardial dysfunction and coronary artery changes) in the majority of children during follow-up.

Longitudinal Cardiac Outcomes of Multisystem Inflammatory Syndrome in Children: A Systematic Review and Meta-Analysis

“…We synthesized outcomes at 3 months from 2 studies [ 27 , 31 ] which explicitly included a follow-up at 3 months and 3 studies [ 17 , 20 , 30 ] which reported data at 100–105 days. We also synthesized outcomes at 6 months from 7 studies [ 16 – 19 , 28 , 29 , 31 ] which included data at 6 months or 180 days follow-up. A summary of the risk of bias assessment for the prevalence studies for each retrospective cohort study is shown in Supplementary Table 1.…”

Advanced Echocardiographic Analysis in Medium-Term Follow-Up of Children with Previous Multisystem Inflammatory Syndrome

“…The cardiovascular system is one of the main systems involved and it is the major determinant of the acute management and prognosis. Many reports documented a good short-term outcome, but little is known about medium- and long-term follow-ups, and to date, there is only one pediatric paper reporting 3–6-month outcomes, although without insight into the cardiologic aspects [ 31 ]. According to the available literature, the LVEF evaluated by a traditional echocardiogram tends to normalize within 7–10 days after acute treatment.…”

Clinical profile of multisystem inflammatory syndrome in children associated with COVID-19 in a rural medical college

“…13 Two Indian studies from northern and eastern India showed the median age to be 6 years and 7 years respectively. 14,15 One study from Kerala found the mean age to be 6.2 years. We may infer from the above that MIS-C is a disorder of children aged more than five years, in contrast to the KD where children of age less than 5 years are mostly affected.…”

“…Only few studies found girls to be affected more. 2,3,8,[13][14][15][16][17] Most of the cases recovered. Only 4 (6%) patients died in this study.…”

“…2,3,11 However Indian studies have reported mortality rate ranging from 0 to 27.5%. [13][14][15][16][18][19][20] Mortality was higher in children with associated co-morbidities. Two out of four children (50%) died who had co-morbidities.…”