ABSTRACT
Background: Children develop severe COVID-19 much less often than adults. However, a small proportion of children present with a complication, known as a multisystem inflammatory syndrome (MIS-C) sometimes associated with admission to an intensive care unit or death. Clinical presentation and consequences of MIS-C are still unclear. The aim of our study is to assess the features of MIS-C and its consequences on a child's health. Method: An observational longitudinal study of children and adolescents hospitalised from May 17 to October 26, 2020, with MIS-C to Morozovskaya Children's City Clinical Hospital, Moscow Department of Health Care, Moscow, Russia. Results: 37 children with MIS-C (meeting WHO, CDC, or RCPCH criteria) were hospitalised. The median age was 6 years (interquartile range 3.3-9.9 years), and 22 patients (59.5%) were male. The most common symptoms on admission were fever (97.3%), fatigue (86.5%), scleritis (85%), oral mucosal inflammation (83.8%), rash (70.3%), tachycardia (51.4%), nausea (51.4%), bilateral conjunctivitis (43.2%), cervical lymphadenopathy (43.2%). The most common laboratory abnormalities detected during hospitalization were elevated CRP (100%), ferritin (100%), D-dimer (89.19%), CRP (86.49%), platelets (85.49%), hypoalbuminemia (100%) and anemia (95.59%). EchoCG abnormalities were present in 6 (16.2%) children with evidence of myocardial dysfunction, 5 (13.5%)-pericarditis, and 3 (8.1%) with a coronary anomaly. The median time from discharge to the first follow-up was 15 days (interquartile range, 14-18 days) to the second follow-up was 47 days (interquartile range, 41-52 days). At the first follow-up, 7/33 (21.21%) children had at least 1 symptom, of whom 5 (15.15%) reported fatigue. At the second follow-up, only 1 child reported a symptom (rash). The normalisation of laboratory values and EchoCG findings was noted in all the children. Conclusion: In spite of the MIS-C severity, the tendency to fast regression of symptoms and laboratory and instrumental indexes is traced, which suggests recovery of children and adolescents from MIS-C without long-term consequences. Further long-term follow-up of patients with MIS-C is necessary since data on long-term health outcomes are limited.
ABSTRACT
Background: The symptoms of the COVID-19 acute phase are well studied, but the long-term sequelae (post-COVID condition) are still poorly characterised. The aim of this study was to evaluate the prevalence of persistent symptoms in previously hospitalised adult patients with COVID-19 and assess risk factors for the post-COVID condition Method: Ambidirectional cohort study of patients over 18 years hospitalised to Sechenov University Hospital Network, Moscow, Russia with clinically diagnosed or laboratory-confirmed COVID-19 between April 8 and July 10, 2020. Study participants were interviewed 6-8 months after discharge via telephone using a follow-up case report form (CRF) developed by ISARIC in collaboration with WHO. Identified symptoms were categorised according to organ systems. Risk factors were assessed by multivariate logistic regression. Results: Among 4,755 patients discharged from the hospitals, 2,649 were subsequently interviewed. The median age of patients was 56 years (46-66), and 1,353 patients (51.1%) were female. The follow-up median time was 217.5 days (200.4-235.5). 1,247 (47.1%) participants reported persistent symptoms (since discharge). The most frequent symptoms were fatigue (21.2%, 551/2599), shortness of breath (14.5%, 378/2614) and forgetfulness (9.1%, 237/2597). Female gender was associated with chronic fatigue with an odds ratio of 1.67 (95% confidence interval 1.39-2.02), neurological 2.03 (1.60-2.58), mental 1.83 (1.41-2.40), respiratory 1.31 (1.06-1.62) and dermatological symptoms 3.26 (2.36-4.57), GI disturbances 2.50 (1.64-3.89) and sensory problems 1.73 (2.06-2.89). Pre-existing asthma was associated with a higher risk of neurological 1.95 (1.25-2.98) and mood and behavioural changes 2.02 (1.24-3.18). Conclusion: Six to eight months after COVID-19 nearly half of patients have symptoms lasting since discharge. The main risk factor for the majority of the development of long-term symptoms was female sex. Asthma may also serve as a risk factor for the post-COVID condition. Further follow-up of patients reporting the persistence of COVID-19 symptoms and the development of interventional approaches for the prevention of post-COVID manifestations are needed.