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Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study

BACKGROUND: SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time. METHODS: We obtained data from chart reviews of children younge...

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Autores principales: Merckx, Joanna, Cooke, Suzette, El Tal, Tala, Bitnun, Ari, Morris, Shaun K., Yeh, E. Ann, Yea, Carmen, Gill, Peter, Papenburg, Jesse, Lefebvre, Marie-Astrid, Scuccimarri, Rosie, Ulloa-Gutierrez, Rolando, Brenes-Chacon, Helena, Yock-Corrales, Adriana, Ivankovich-Escoto, Gabriela, Soriano-Fallas, Alejandra, Mezerville, Marcela Hernandez-de, Dewan, Tammie, Restivo, Lea, Nateghian, Alireza, Aski, Behzad Haghighi, Manafi, Ali, Dwilow, Rachel, Bullard, Jared, Lopez, Alison, Sadarangani, Manish, Roberts, Ashley, Barton, Michelle, Petel, Dara, Le Saux, Nicole, Bowes, Jennifer, Purewal, Rupeena, Lautermilch, Janell, Tehseen, Sarah, Bayliss, Ann, Wong, Jacqueline K., Leifso, Kirk, Foo, Cheryl, Robinson, Joan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: CMA Impact Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9001008/
https://www.ncbi.nlm.nih.gov/pubmed/35410860
http://dx.doi.org/10.1503/cmaj.210873
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author Merckx, Joanna
Cooke, Suzette
El Tal, Tala
Bitnun, Ari
Morris, Shaun K.
Yeh, E. Ann
Yea, Carmen
Gill, Peter
Papenburg, Jesse
Lefebvre, Marie-Astrid
Scuccimarri, Rosie
Ulloa-Gutierrez, Rolando
Brenes-Chacon, Helena
Yock-Corrales, Adriana
Ivankovich-Escoto, Gabriela
Soriano-Fallas, Alejandra
Mezerville, Marcela Hernandez-de
Dewan, Tammie
Restivo, Lea
Nateghian, Alireza
Aski, Behzad Haghighi
Manafi, Ali
Dwilow, Rachel
Bullard, Jared
Lopez, Alison
Sadarangani, Manish
Roberts, Ashley
Barton, Michelle
Petel, Dara
Le Saux, Nicole
Bowes, Jennifer
Purewal, Rupeena
Lautermilch, Janell
Tehseen, Sarah
Bayliss, Ann
Wong, Jacqueline K.
Leifso, Kirk
Foo, Cheryl
Robinson, Joan
author_facet Merckx, Joanna
Cooke, Suzette
El Tal, Tala
Bitnun, Ari
Morris, Shaun K.
Yeh, E. Ann
Yea, Carmen
Gill, Peter
Papenburg, Jesse
Lefebvre, Marie-Astrid
Scuccimarri, Rosie
Ulloa-Gutierrez, Rolando
Brenes-Chacon, Helena
Yock-Corrales, Adriana
Ivankovich-Escoto, Gabriela
Soriano-Fallas, Alejandra
Mezerville, Marcela Hernandez-de
Dewan, Tammie
Restivo, Lea
Nateghian, Alireza
Aski, Behzad Haghighi
Manafi, Ali
Dwilow, Rachel
Bullard, Jared
Lopez, Alison
Sadarangani, Manish
Roberts, Ashley
Barton, Michelle
Petel, Dara
Le Saux, Nicole
Bowes, Jennifer
Purewal, Rupeena
Lautermilch, Janell
Tehseen, Sarah
Bayliss, Ann
Wong, Jacqueline K.
Leifso, Kirk
Foo, Cheryl
Robinson, Joan
author_sort Merckx, Joanna
collection PubMed
description BACKGROUND: SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time. METHODS: We obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement. RESULTS: Of 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13–17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6–12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 μg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI −0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%). INTERPRETATION: We observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined.
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spelling pubmed-90010082022-04-15 Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study Merckx, Joanna Cooke, Suzette El Tal, Tala Bitnun, Ari Morris, Shaun K. Yeh, E. Ann Yea, Carmen Gill, Peter Papenburg, Jesse Lefebvre, Marie-Astrid Scuccimarri, Rosie Ulloa-Gutierrez, Rolando Brenes-Chacon, Helena Yock-Corrales, Adriana Ivankovich-Escoto, Gabriela Soriano-Fallas, Alejandra Mezerville, Marcela Hernandez-de Dewan, Tammie Restivo, Lea Nateghian, Alireza Aski, Behzad Haghighi Manafi, Ali Dwilow, Rachel Bullard, Jared Lopez, Alison Sadarangani, Manish Roberts, Ashley Barton, Michelle Petel, Dara Le Saux, Nicole Bowes, Jennifer Purewal, Rupeena Lautermilch, Janell Tehseen, Sarah Bayliss, Ann Wong, Jacqueline K. Leifso, Kirk Foo, Cheryl Robinson, Joan CMAJ Research BACKGROUND: SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time. METHODS: We obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement. RESULTS: Of 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13–17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6–12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 μg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI −0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%). INTERPRETATION: We observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined. CMA Impact Inc. 2022-04-11 2022-04-11 /pmc/articles/PMC9001008/ /pubmed/35410860 http://dx.doi.org/10.1503/cmaj.210873 Text en © 2022 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Research
Merckx, Joanna
Cooke, Suzette
El Tal, Tala
Bitnun, Ari
Morris, Shaun K.
Yeh, E. Ann
Yea, Carmen
Gill, Peter
Papenburg, Jesse
Lefebvre, Marie-Astrid
Scuccimarri, Rosie
Ulloa-Gutierrez, Rolando
Brenes-Chacon, Helena
Yock-Corrales, Adriana
Ivankovich-Escoto, Gabriela
Soriano-Fallas, Alejandra
Mezerville, Marcela Hernandez-de
Dewan, Tammie
Restivo, Lea
Nateghian, Alireza
Aski, Behzad Haghighi
Manafi, Ali
Dwilow, Rachel
Bullard, Jared
Lopez, Alison
Sadarangani, Manish
Roberts, Ashley
Barton, Michelle
Petel, Dara
Le Saux, Nicole
Bowes, Jennifer
Purewal, Rupeena
Lautermilch, Janell
Tehseen, Sarah
Bayliss, Ann
Wong, Jacqueline K.
Leifso, Kirk
Foo, Cheryl
Robinson, Joan
Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study
title Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study
title_full Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study
title_fullStr Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study
title_full_unstemmed Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study
title_short Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study
title_sort predictors of severe illness in children with multisystem inflammatory syndrome after sars-cov-2 infection: a multicentre cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9001008/
https://www.ncbi.nlm.nih.gov/pubmed/35410860
http://dx.doi.org/10.1503/cmaj.210873
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