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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.
  • Merckx J; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Cooke S; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • El Tal T; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Bitnun A; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Morris SK; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Yeh EA; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Yea C; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Gill P; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Papenburg J; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Lefebvre MA; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Scuccimarri R; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Ulloa-Gutierrez R; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Brenes-Chacon H; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Yock-Corrales A; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Ivankovich-Escoto G; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Soriano-Fallas A; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Mezerville MH; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Dewan T; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Restivo L; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Nateghian A; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Aski BH; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Manafi A; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Dwilow R; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Bullard J; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Lopez A; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Sadarangani M; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Roberts A; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Barton M; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Petel D; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Le Saux N; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Bowes J; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Purewal R; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Lautermilch J; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Tehseen S; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Bayliss A; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Wong JK; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Leifso K; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Foo C; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
  • Robinson J; Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, O
CMAJ ; 194(14): E513-E523, 2022 04 11.
Article in English | MEDLINE | ID: covidwho-2089467
ABSTRACT

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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Connective Tissue Diseases / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Variants Limits: Child / Child, preschool / Humans / Male Country/Region as subject: North America Language: English Journal: CMAJ Journal subject: Medicine Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Connective Tissue Diseases / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Variants Limits: Child / Child, preschool / Humans / Male Country/Region as subject: North America Language: English Journal: CMAJ Journal subject: Medicine Year: 2022 Document Type: Article