1. Longitudinal Outcomes for Multisystem Inflammatory Syndrome in Children
- Author
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Kanwal M. Farooqi, Brett R. Anderson, Erika B. Rosenzweig, Amee Shah, Usha Krishnan, Junhui Mi, Pengfei Jiang, Michael P. DiLorenzo, Elizabeth Abrahams, Angela Chan, Nikhil Pasumarti, Anne Ferris, Philip Zachariah, Mark Gorelik, Sanghee Suh, Rachel Weller, and Joshua D. Milner
- Subjects
Male ,Chemokine ,medicine.medical_specialty ,Critical Care ,New York ,Aftercare ,Inflammation ,Gastroenterology ,Interquartile range ,Intensive care ,Internal medicine ,medicine ,Humans ,Child ,Pandemics ,Retrospective Studies ,biology ,business.industry ,COVID-19 ,Infant ,Interleukin ,Retrospective cohort study ,medicine.disease ,Patient Discharge ,Systemic Inflammatory Response Syndrome ,Systemic inflammatory response syndrome ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cohort ,biology.protein ,Female ,medicine.symptom ,business ,Follow-Up Studies - Abstract
BACKGROUND In spring 2020, a novel hyperinflammatory process associated with severe acute respiratory syndrome coronavirus 2 multisystem inflammatory syndrome in children (MIS-C) was described. The long-term impact remains unknown. We report longitudinal outcomes from a New York interdisciplinary follow-up program. METHODS All children RESULTS In total, 45 children were admitted with MIS-C. The median time to last follow-up was 5.8 months (interquartile range 1.3–6.7). Of those admitted, 76% required intensive care and 64% required vasopressors and/or inotropes. On admission, patients exhibited significant nonspecific inflammation, generalized lymphopenia, and thrombocytopenia. Soluble interleukin (IL) IL-2R, IL-6, IL-10, IL-17, IL-18, and C-X-C Motif Chemokine Ligand 9 were elevated. A total of 80% (n = 36) had at least mild and 44% (n = 20) had moderate-severe echocardiographic abnormalities including coronary abnormalities (9% had a z score of 2–2.5; 7% had a z score > 2.5). Whereas most inflammatory markers normalized by 1 to 4 weeks, 32% (n = 11 of 34) exhibited persistent lymphocytosis, with increased double-negative T cells in 96% of assessed patients (n = 23 of 24). By 1 to 4 weeks, only 18% (n = 7 of 39) had mild echocardiographic findings; all had normal coronaries. At 1 to 4 months, the proportion of double-negative T cells remained elevated in 92% (median 9%). At 4 to 9 months, only 1 child had persistent mild dysfunction. One had mild mitral and/or tricuspid regurgitation. CONCLUSIONS Although the majority of children with MIS-C present critically ill, most inflammatory and cardiac manifestations in our cohort resolved rapidly.
- Published
- 2021