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Multisystem Inflammatory Syndrome of Children: Subphenotypes, Risk Factors, Biomarkers, Cytokine Profiles, and Viral Sequencing.
DeBiasi, Roberta L; Harahsheh, Ashraf S; Srinivasalu, Hemalatha; Krishnan, Anita; Sharron, Matthew P; Parikh, Kavita; Smith, Karen; Bell, Michael; Michael, Drew; Delaney, Meghan; Campos, Joseph; Vilain, Eric; LoTempio, Jonathan; Kline, Jaclyn N; Ronis, Tova; Majumdar, Suvankar; Sadler, Eleanor; Conway, Susan R; Berul, Charles I; Sule, Sangeeta; Lahoz, Rebeca; Ansusinha, Emily; Pershad, Jay; Bundy, Vanessa; Wells, Elizabeth; Bost, James E; Wessel, David.
  • DeBiasi RL; Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC; Division of Cardiology, Children's National Hospital, Washington, DC; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Department of Microbiology, Immunology and Tropical Medicine, Was
  • Harahsheh AS; Division of Cardiology, Children's National Hospital, Washington, DC; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC.
  • Srinivasalu H; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Rheumatology, Children's National Hospital, Washington, DC.
  • Krishnan A; Division of Cardiology, Children's National Hospital, Washington, DC; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC.
  • Sharron MP; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Critical Care Medicine, Children's National Hospital, Washington, DC.
  • Parikh K; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Hospitalist Medicine, Children's National Hospital, Washington, DC.
  • Smith K; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Hospitalist Medicine, Children's National Hospital, Washington, DC.
  • Bell M; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Critical Care Medicine, Children's National Hospital, Washington, DC.
  • Michael D; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Laboratory Medicine and Pathology, Children's National Hospital, Washington, DC; Department of Pathology, The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Gen
  • Delaney M; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Laboratory Medicine and Pathology, Children's National Hospital, Washington, DC.
  • Campos J; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Laboratory Medicine and Pathology, Children's National Hospital, Washington, DC.
  • Vilain E; Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC; Center for Genetic Medicine Research, Children's Research Institute, Washington, DC.
  • LoTempio J; Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC; Center for Genetic Medicine Research, Children's Research Institute, Washington, DC.
  • Kline JN; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Emergency Medicine, Children's National Hospital, Washington, DC.
  • Ronis T; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Rheumatology, Children's National Hospital, Washington, DC.
  • Majumdar S; Division of Critical Care Medicine, Children's National Hospital, Washington, DC; Division of Hematology, Children's National Hospital, Washington, DC.
  • Sadler E; Division of Pharmacy, The Mount Sinai Hospital, New York, New York.
  • Conway SR; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Critical Care Medicine, Children's National Hospital, Washington, DC.
  • Berul CI; Division of Cardiology, Children's National Hospital, Washington, DC; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC.
  • Sule S; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Rheumatology, Children's National Hospital, Washington, DC.
  • Lahoz R; Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC.
  • Ansusinha E; Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC.
  • Pershad J; Division of Emergency Medicine, Children's National Hospital, Washington, DC.
  • Bundy V; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Immunology, Children's National Hospital, Washington, DC.
  • Wells E; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Neurology, Children's National Hospital, Washington, DC.
  • Bost JE; Division of Biostatistics, Children's National Hospital, Washington, DC.
  • Wessel D; Division of Cardiology, Children's National Hospital, Washington, DC; Department of Pediatrics, Immunology and Tropical Medicine, Washington, DC; Division of Critical Care Medicine, Children's National Hospital, Washington, DC.
J Pediatr ; 237: 125-135.e18, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1316558
ABSTRACT

OBJECTIVE:

To assess demographic, clinical, and biomarker features distinguishing patients with multisystem inflammatory syndrome in children (MIS-C); compare MIS-C sub-phenotypes; identify cytokine biosignatures; and characterize viral genome sequences. STUDY

DESIGN:

We performed a prospective observational cohort study of 124 children hospitalized and treated under the institutional MIS-C Task Force protocol from March to September 2020 at Children's National, a quaternary freestanding children's hospital in Washington, DC. Of this cohort, 63 of the patients had the diagnosis of MIS-C (39 confirmed, 24 probable) and 61 were from the same cohort of admitted patients who subsequently had an alternative diagnosis (controls).

RESULTS:

Median age and sex were similar between MIS-C and controls. Black (46%) and Latino (35%) children were over-represented in the MIS-C cohort, with Black children at greatest risk (OR 4.62, 95% CI 1.151-14.10; P = .007). Cardiac complications were more frequent in critically ill patients with MIS-C (55% vs 28%; P = .04) including systolic myocardial dysfunction (39% vs 3%; P = .001) and valvular regurgitation (33% vs 7%; P = .01). Median cycle threshold was 31.8 (27.95-35.1 IQR) in MIS-C cases, significantly greater (indicating lower viral load) than in primary severe acute respiratory syndrome coronavirus 2 infection. Cytokines soluble interleukin 2 receptor, interleukin [IL]-10, and IL-6 were greater in patients with MIS-C compared with controls. Cytokine analysis revealed subphenotype differences between critically ill vs noncritically ill (IL-2, soluble interleukin 2 receptor, IL-10, IL-6); polymerase chain reaction positive vs negative (tumor necrosis factor-α, IL-10, IL-6); and presence vs absence of cardiac abnormalities (IL-17). Phylogenetic analysis of viral genome sequences revealed predominance of GH clade originating in Europe, with no differences comparing patients with MIS-C with patients with primary coronavirus disease 19. Treatment was well tolerated, and no children died.

CONCLUSIONS:

This study establishes a well-characterized large cohort of MIS-C evaluated and treated following a standardized protocol and identifies key clinical, biomarker, cytokine, viral load, and sequencing features. Long-term follow-up will provide opportunity for future insights into MIS-C and its sequelae.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Cardiovascular Diseases / Systemic Inflammatory Response Syndrome / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Language: English Journal: J Pediatr Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cardiovascular Diseases / Systemic Inflammatory Response Syndrome / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Language: English Journal: J Pediatr Year: 2021 Document Type: Article