PT  - JOURNAL ARTICLE
AU  - Joanna Merckx
AU  - Suzette Cooke
AU  - Tala El Tal
AU  - Ari Bitnun
AU  - Shaun K. Morris
AU  - E. Ann Yeh
AU  - Carmen Yea
AU  - Peter Gill
AU  - Jesse Papenburg
AU  - Marie-Astrid Lefebvre
AU  - Rosie Scuccimarri
AU  - Rolando Ulloa-Gutierrez
AU  - Helena Brenes-Chacon
AU  - Adriana Yock-Corrales
AU  - Gabriela Ivankovich-Escoto
AU  - Alejandra Soriano-Fallas
AU  - Marcela Hernandez-de Mezerville
AU  - Tammie Dewan
AU  - Lea Restivo
AU  - Alireza Nateghian
AU  - Behzad Haghighi Aski
AU  - Ali Manafi
AU  - Rachel Dwilow
AU  - Jared Bullard
AU  - Alison Lopez
AU  - Manish Sadarangani
AU  - Ashley Roberts
AU  - Michelle Barton
AU  - Dara Petel
AU  - Nicole Le Saux
AU  - Jennifer Bowes
AU  - Rupeena Purewal
AU  - Janell Lautermilch
AU  - Sarah Tehseen
AU  - Ann Bayliss
AU  - Jacqueline K. Wong
AU  - Kirk Leifso
AU  - Cheryl Foo
AU  - Joan Robinson
ED  - ,
TI  - Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study
AID  - 10.1503/cmaj.210873
DP  - 2022 Apr 11
TA  - Canadian Medical Association Journal
PG  - E513--E523
VI  - 194
IP  - 14
4099  - http://www.cmaj.ca/content/194/14/E513.short
4100  - http://www.cmaj.ca/content/194/14/E513.full
SO  - CMAJ2022 Apr 11; 194
AB  - 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.