Background

Multisystem inflammatory syndrome in children (MIS-C) is a newly identified and serious health condition associated with SARS-CoV-2 infection. Clinical manifestations vary widely among patients with MIS-C, and the aim of this study was to investigate factors associated with severe outcomes.

Methods

In this retrospective surveillance study, patients who met the US Centers for Disease Control and Prevention (CDC) case definition for MIS-C (younger than 21 years, fever, laboratory evidence of inflammation, admitted to hospital, multisystem [≥2] organ involvement [cardiac, renal, respiratory, haematological, gastrointestinal, dermatological, or neurological], no alternative plausible diagnosis, and either laboratory confirmation of SARS-CoV-2 infection by RT-PCR, serology, or antigen test, or known COVID-19 exposure within 4 weeks before symptom onset) were reported from state and local health departments to the CDC using standard case-report forms. Factors assessed for potential links to severe outcomes included pre-existing patient factors (sex, age, race or ethnicity, obesity, and MIS-C symptom onset date before June 1, 2020) and clinical findings (signs or symptoms and laboratory markers). Logistic regression models, adjusted for all pre-existing factors, were used to estimate odds ratios between potential explanatory factors and the following outcomes: intensive care unit (ICU) admission, shock, decreased cardiac function, myocarditis, and coronary artery abnormalities.

Findings

1080 patients met the CDC case definition for MIS-C and had symptom onset between March 11 and Oct 10, 2020. ICU admission was more likely in patients aged 6–12 years (adjusted odds ratio 1·9 [95% CI 1·4–2·6) and patients aged 13–20 years (2·6 [1·8–3·8]), compared with patients aged 0–5 years, and more likely in non-Hispanic Black patients, compared with non-Hispanic White patients (1·6 [1·0–2·4]). ICU admission was more likely for patients with shortness of breath (1·9 [1·2–2·9]), abdominal pain (1·7 [1·2–2·7]), and patients with increased concentrations of C-reactive protein, troponin, ferritin, D-dimer, brain natriuretic peptide (BNP), N-terminal pro B-type BNP, or interleukin-6, or reduced platelet or lymphocyte counts. We found similar associations for decreased cardiac function, shock, and myocarditis. Coronary artery abnormalities were more common in male patients (1·5 [1·1–2·1]) than in female patients and patients with mucocutaneous lesions (2·2 [1·3–3·5]) or conjunctival injection (2·3 [1·4–3·7]).

Interpretation

Identification of important demographic and clinical characteristics could aid in early recognition and prompt management of severe outcomes for patients with MIS-C.

Funding

None.

中文翻译：

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美国儿童多系统炎症综合征 (MIS-C) 严重结局的相关因素：一项回顾性监测研究

背景

儿童多系统炎症综合征 (MIS-C) 是一种新发现的与 SARS-CoV-2 感染相关的严重健康状况。MIS-C 患者的临床表现差异很大，本研究的目的是调查与严重结果相关的因素。

方法

在这项回顾性监测研究中，符合美国疾病控制和预防中心 (CDC) MIS-C 病例定义的患者（年龄小于 21 岁、发热、实验室有炎症证据、入院、多系统 [≥2] 器官受累） [心脏、肾脏、呼吸系统、血液系统、胃肠系统、皮肤系统或神经系统]，没有其他似是而非的诊断，以及通过 RT-PCR、血清学或抗原测试确认 SARS-CoV-2 感染的实验室，或已知的 COVID-19 暴露症状出现前 4 周内）从州和地方卫生部门使用标准病例报告表报告给 CDC。评估与严重结果的潜在联系的因素包括先前存在的患者因素（性别、年龄、种族或民族、肥胖和 MIS-C 症状发作日期在 6 月 1 日之前，2020）和临床发现（体征或症状和实验室标志物）。对所有预先存在的因素进行调整的逻辑回归模型用于估计潜在解释因素与以下结果之间的比值比：重症监护病房 (ICU) 入院、休克、心功能下降、心肌炎和冠状动脉异常。

发现

1080 名患者符合 CDC 对 MIS-C 的病例定义，并在 2020 年 3 月 11 日至 10 月 10 日期间出现症状。6-12 岁的患者更有可能入住 ICU（调整优势比 1·9 [95% CI 1·4 –2·6) 和 13-20 岁的患者 (2·6 [1·8-3·8])，与 0-5 岁的患者相比，非西班牙裔黑人患者与非西班牙裔黑人患者相比更有可能西班牙裔白人患者 (1·6 [1·0–2·4])。呼吸急促 (1·9 [1·2-2·9])、腹痛 (1·7 [1·2-2·7]) 和 C 浓度升高的患者更有可能入住 ICU -反应蛋白、肌钙蛋白、铁蛋白、D-二聚体、脑利钠肽 (BNP)、N 端前 B 型 BNP 或白细胞介素 6，或血小板或淋巴细胞计数减少。我们发现心脏功能下降、休克和心肌炎有类似的关联。

解释

识别重要的人口统计学和临床​​特征有助于早期识别和及时管理 MIS-C 患者的严重后果。

资金

没有任何。