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Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 shares clinical features with viral myocarditis, Kawasaki disease, Kawasaki shock syndrome, and toxic shock syndrome. Whereas cardiovascular complications are common in these other syndromes, data are lacking on the cardiovascular complications of COVID-19–associated MIS-C. Investigators have now evaluated clinical data of 286 children (median age, 8.4; 67.8% male) with MIS-C from 55 centers in 48 cities across 17 European countries from February 1 to June 6, 2020.
Of the patients, 65% had current or previous COVID-19 infection based on polymerase chain reaction for SARS-CoV2 nucleic acid or serology. Of 14 children with a positive screen for other viruses, 8 also had a positive SARS-CoV2 test. Common symptoms were fever (96.5%), gastrointestinal symptoms (71.3%), rash (62.6%), conjunctival injection (54.5%), oral mucosal hyperemia (40.6%), and shock (40.2%). Abnormal laboratory values included elevated B-type natriuretic peptide (95%), procalcitonin (96%), C-reactive protein (99%), cardiac troponin (93%), D-dimer (90%), and interleukin-6 (88%). Degree of elevation in cardiac and biochemical markers correlated significantly with need for intensive care. Despite 65% having normal admission electrocardiograms, 26.7% had coronary artery dilatation on cardiac CT and 23.8% had pericardial effusion on cardiac MRI during hospitalization. Also during hospitalization, echocardiography showed mitral regurgitation (30%) and pericardial effusion (21%); a few patients showed coronary artery aneurysmal changes, most commonly in the left-main and left-anterior descending coronary arteries. Most patients received intravenous immunoglobulin (78.3%) and aspirin (74%). Additional notable therapies included steroids (28%), heparin (37.8%), and diuretics (61%). Most patients (97.2%) were discharged home, 2.4% remained in hospital, and one died (with ventricular arrhythmias).
Valverde I et al. Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation 2020 Nov 9; [e-pub]. (https://doi.org/10.1161/CIRCULATIONAHA.120.050065)
Comment
Children with COVID-19–associated MIS-C commonly develop shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Compared with adults, death in children with MIS is uncommon despite significantly elevated inflammatory markers and multisystem involvement. Most patients received intravenous immunoglobulin, which is rarely given to adults. Whether this or other treatment differences affect mortality remains to be determined.