Older children, those with high ferritin at greater risk for severe MIS-C after COVID-19
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Older children and those with ferritin levels greater than 500 µg/L are at highest risk for severe multisystem inflammatory syndrome in children resulting in ICU admission after COVID-19, according to data published in CMAJ.
“This study shows that the severity of MIS-C may not be a constant and may be influenced by the COVID-19 variant that infected the child,” Joan Robinson, MD, of the University of Alberta, told Healio. “Clinicians should consider the diagnosis in all children with unexplained fever but especially in those with rash and gastrointestinal symptoms.”
To examine the risk factors for severe disease and ICU admission due to MIS-C following COVID-19, as well as changes in disease severity over time, Merckx and colleagues studied data from chart reviews of 232 children across 15 hospitals in Canada, Iran and Costa Rica between March 1, 2020, and March 7, 2021. Included patients were aged younger than 18 years and had confirmed or probable MIS-C.
The researchers used multivariable analyses to assess whether admission date and other factors were associated with ICU admission or cardiac involvement. In all, 21.6% of included patients demonstrated comorbidities and 31.5% were admitted to the ICU. There were no deaths.
According to the researchers, there was an increased risk for ICU admission among children aged 13 to 17 years (adjusted risk difference = 27.7%; 95% CI, 8.3% to 47.2%), those aged 6 to 12 years (25.2%; 95% CI, 13.6% to 36.9%) or those with initial ferritin levels greater than 500 µg/L (18.4%; 95% CI, 5.6% to 31.3%). Patients who presented to the hospital after Oct. 31, 2020, demonstrated numerically higher rates of ICU admission (12.3%; 95% CI, –0.3% to 25%) and significantly higher rates of cardiac involvement (30.9%; 95% CI, 17.3% to 44.4%).
At Canadian sites, the risk for ICU admission was significantly higher for patients admitted to the hospital between December 2020 and March 2021, compared with those admitted between March and May 2020 (25.3%; 95% CI, 6.5% to 44%).
“Older age and a high initial level of serum ferritin predict the need for ICU admission among children admitted to hospital with MIS-C,” Merckx and colleagues wrote. “Further research is needed to evaluate long-term outcomes of MIS-C with and without treatment, as well as changes in MIS-C severity and short- and long-term outcomes with emerging variants of concern.”
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