RT Journal Article
SR Electronic
T1 Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E513
OP E523
DO 10.1503/cmaj.210873
VO 194
IS 14
A1 Merckx, Joanna
A1 Cooke, Suzette
A1 El Tal, Tala
A1 Bitnun, Ari
A1 Morris, Shaun K.
A1 Yeh, E. Ann
A1 Yea, Carmen
A1 Gill, Peter
A1 Papenburg, Jesse
A1 Lefebvre, Marie-Astrid
A1 Scuccimarri, Rosie
A1 Ulloa-Gutierrez, Rolando
A1 Brenes-Chacon, Helena
A1 Yock-Corrales, Adriana
A1 Ivankovich-Escoto, Gabriela
A1 Soriano-Fallas, Alejandra
A1 Mezerville, Marcela Hernandez-de
A1 Dewan, Tammie
A1 Restivo, Lea
A1 Nateghian, Alireza
A1 Aski, Behzad Haghighi
A1 Manafi, Ali
A1 Dwilow, Rachel
A1 Bullard, Jared
A1 Lopez, Alison
A1 Sadarangani, Manish
A1 Roberts, Ashley
A1 Barton, Michelle
A1 Petel, Dara
A1 Le Saux, Nicole
A1 Bowes, Jennifer
A1 Purewal, Rupeena
A1 Lautermilch, Janell
A1 Tehseen, Sarah
A1 Bayliss, Ann
A1 Wong, Jacqueline K.
A1 Leifso, Kirk
A1 Foo, Cheryl
A1 Robinson, Joan
A1 
YR 2022
UL http://www.cmaj.ca/content/194/14/E513.abstract
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.