Heart, inflammatory issues resolve rapidly in MIS-C, study finds
Heart and inflammatory issues experienced by pediatric patients hospitalized with multisystem inflammatory syndrome in children mostly resolved within a few months, according to a study published in Pediatrics.
Kanwal M. Farooqi, MD, an assistant professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons, and colleagues enrolled 45 patients aged younger than 21 years who were admitted to New York-Presbyterian Hospital in 2020 with multisystem inflammatory syndrome in children (MIS-C), a rare but serious syndrome associated with SARS-CoV-2 infection.
The median age of the patients in the study was 9 years. Upon admission, 80% (n = 36) had at least mild and 44% (n = 20) had moderate to severe echocardiographic abnormalities, including coronary abnormalities, the researchers reported.
“It was both challenging and scary, because we didn't know how these patients would do long term, especially in terms of cardiac and immunologic abnormalities, which were the most prominent issues at the time,” Farooqi said in a new release.
According to the release, physicians treated the children with steroids, IV immunoglobulin and immunomodulators, and blood pressure medication, and one-third received respiratory support, although none required extracorporeal membrane oxygenation.
"These kids were quite sick, but at our hospital, where we began using steroids and other treatments routinely for MIS-C, most of the patients responded rapidly and were discharged by about 5 days," Farooqi said in the release.
The researchers found that most inflammatory markers normalized within 1 to 4 weeks, but 32% (n = 11) of patients exhibited persistent lymphocytosis, with increased double-negative T cells in 96% of assessed patients (n = 23 of 24).
All children were followed up at 1 to 4 weeks, 1 to 4 months and 4 to 9 months after being discharged. The median follow-up time was 5.8 months.
By weeks 1 to 4, 18% (n = 7 of 39) had mild echocardiographic findings, and all had normal coronaries. At 1 to 4 months, the proportion of double-negative T cells remained elevated in 92% of patients. At 4 to 9 months, only one child had persistent mild dysfunction.
“It is a relief that this study shows that most of the severe heart and immunologic manifestations we saw in kids with MIS-C resolved rapidly,” Farooqi said.