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Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a severe disease with an unpredictable course and a substantial risk of cardiogenic shock. Our objectives were to (a) compare MIS-C phenotypes across the COVID-19 pandemic, (b) identify features associated with intensive care need...

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Autores principales: Renson, Thomas, Forkert, Nils D., Amador, Kimberly, Miettunen, Paivi, Parsons, Simon J., Dhalla, Muhammed, Johnson, Nicole A., Luca, Nadia, Schmeling, Heinrike, Stevenson, Rebeka, Twilt, Marinka, Hamiwka, Lorraine, Benseler, Susanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092941/
https://www.ncbi.nlm.nih.gov/pubmed/37046304
http://dx.doi.org/10.1186/s12969-023-00815-w
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author Renson, Thomas
Forkert, Nils D.
Amador, Kimberly
Miettunen, Paivi
Parsons, Simon J.
Dhalla, Muhammed
Johnson, Nicole A.
Luca, Nadia
Schmeling, Heinrike
Stevenson, Rebeka
Twilt, Marinka
Hamiwka, Lorraine
Benseler, Susanne
author_facet Renson, Thomas
Forkert, Nils D.
Amador, Kimberly
Miettunen, Paivi
Parsons, Simon J.
Dhalla, Muhammed
Johnson, Nicole A.
Luca, Nadia
Schmeling, Heinrike
Stevenson, Rebeka
Twilt, Marinka
Hamiwka, Lorraine
Benseler, Susanne
author_sort Renson, Thomas
collection PubMed
description BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a severe disease with an unpredictable course and a substantial risk of cardiogenic shock. Our objectives were to (a) compare MIS-C phenotypes across the COVID-19 pandemic, (b) identify features associated with intensive care need and treatment with biologic agents. METHODS: Youth aged 0–18 years, fulfilling the World Health Organization case definition of MIS-C, and admitted to the Alberta Children’s Hospital during the first four waves of the COVID-19 pandemic (May 2020-December 2021) were included in this cohort study. Demographic, clinical, biochemical, imaging, and treatment data were captured. RESULTS: Fifty-seven MIS-C patients (median age 6 years, range 0–17) were included. Thirty patients (53%) required intensive care. Patients in the third or fourth wave (indicated as phase 2 of the pandemic) presented with higher peak ferritin (µg/l, median (IQR) = 1134 (409–1806) vs. 370 (249–629), P = 0.001), NT-proBNP (ng/l, median (IQR) = 12,217 (3013–27,161) vs. 3213 (1216–8483), P = 0.02) and D-dimer (mg/l, median (IQR) = 4.81 (2.24–5.37) vs. 2.01 (1.27–3.34), P = 0.004) levels, and higher prevalence of liver enzyme abnormalities (n(%) = 17 (68) vs. 11 (34), P = 0.02), hypoalbuminemia (n(%) = 24 (100) vs. 25 (81), P = 0.03) and thrombocytopenia (n(%) 18 (72) vs. 11 (34), P = 0.007) compared to patients in the first two waves (phase 1). These patients had a higher need of non-invasive/mechanical ventilation (n(%) 4 (16) vs. 0 (0), P = 0.03). Unsupervised clustering analyses classified 47% of the patients in the correct wave and 74% in the correct phase of the pandemic. NT-proBNP was the only significant contributor to the need for intensive care in all applied multivariate regression models. Treatment with biologic agents was significantly associated with peak CRP (mg/l (median, IQR = 240.9 (132.9-319.4) vs. 155.8 (101.0-200.7), P = 0.02) and ferritin levels (µg/l, median (IQR) = 1380 (509–1753) vs. 473 (280–296)). CONCLUSIONS: MIS-C patients in a later stage of the pandemic displayed a more severe phenotype, reflecting the impact of distinct SARS-CoV-2 variants. NT-proBNP emerged as the most crucial feature associated with intensive care need, underscoring the importance of monitoring. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12969-023-00815-w.
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spelling pubmed-100929412023-04-14 Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study Renson, Thomas Forkert, Nils D. Amador, Kimberly Miettunen, Paivi Parsons, Simon J. Dhalla, Muhammed Johnson, Nicole A. Luca, Nadia Schmeling, Heinrike Stevenson, Rebeka Twilt, Marinka Hamiwka, Lorraine Benseler, Susanne Pediatr Rheumatol Online J Research Article BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a severe disease with an unpredictable course and a substantial risk of cardiogenic shock. Our objectives were to (a) compare MIS-C phenotypes across the COVID-19 pandemic, (b) identify features associated with intensive care need and treatment with biologic agents. METHODS: Youth aged 0–18 years, fulfilling the World Health Organization case definition of MIS-C, and admitted to the Alberta Children’s Hospital during the first four waves of the COVID-19 pandemic (May 2020-December 2021) were included in this cohort study. Demographic, clinical, biochemical, imaging, and treatment data were captured. RESULTS: Fifty-seven MIS-C patients (median age 6 years, range 0–17) were included. Thirty patients (53%) required intensive care. Patients in the third or fourth wave (indicated as phase 2 of the pandemic) presented with higher peak ferritin (µg/l, median (IQR) = 1134 (409–1806) vs. 370 (249–629), P = 0.001), NT-proBNP (ng/l, median (IQR) = 12,217 (3013–27,161) vs. 3213 (1216–8483), P = 0.02) and D-dimer (mg/l, median (IQR) = 4.81 (2.24–5.37) vs. 2.01 (1.27–3.34), P = 0.004) levels, and higher prevalence of liver enzyme abnormalities (n(%) = 17 (68) vs. 11 (34), P = 0.02), hypoalbuminemia (n(%) = 24 (100) vs. 25 (81), P = 0.03) and thrombocytopenia (n(%) 18 (72) vs. 11 (34), P = 0.007) compared to patients in the first two waves (phase 1). These patients had a higher need of non-invasive/mechanical ventilation (n(%) 4 (16) vs. 0 (0), P = 0.03). Unsupervised clustering analyses classified 47% of the patients in the correct wave and 74% in the correct phase of the pandemic. NT-proBNP was the only significant contributor to the need for intensive care in all applied multivariate regression models. Treatment with biologic agents was significantly associated with peak CRP (mg/l (median, IQR = 240.9 (132.9-319.4) vs. 155.8 (101.0-200.7), P = 0.02) and ferritin levels (µg/l, median (IQR) = 1380 (509–1753) vs. 473 (280–296)). CONCLUSIONS: MIS-C patients in a later stage of the pandemic displayed a more severe phenotype, reflecting the impact of distinct SARS-CoV-2 variants. NT-proBNP emerged as the most crucial feature associated with intensive care need, underscoring the importance of monitoring. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12969-023-00815-w. BioMed Central 2023-04-12 /pmc/articles/PMC10092941/ /pubmed/37046304 http://dx.doi.org/10.1186/s12969-023-00815-w Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Renson, Thomas
Forkert, Nils D.
Amador, Kimberly
Miettunen, Paivi
Parsons, Simon J.
Dhalla, Muhammed
Johnson, Nicole A.
Luca, Nadia
Schmeling, Heinrike
Stevenson, Rebeka
Twilt, Marinka
Hamiwka, Lorraine
Benseler, Susanne
Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study
title Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study
title_full Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study
title_fullStr Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study
title_full_unstemmed Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study
title_short Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study
title_sort distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092941/
https://www.ncbi.nlm.nih.gov/pubmed/37046304
http://dx.doi.org/10.1186/s12969-023-00815-w
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