Cardiac Complications in Children with Acute COVID-19 vs. Multi-system Inflammatory Syndrome in Children (MIS-C) Open Access

Hensley, Matthew (Spring 2022)

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           Multisystem Inflammatory Syndrome in Children (MIS-C) is associated with COVID-19 infection, but not much is understood about its pathophysiology and how outcomes of MIS-C differ from those of acute COVID-19 infection. The specific areas of uncertainty and research need include frequency, determinants, and clinical features of cardiovascular involvement among children diagnosed with acute COVID-19 and MIS-C.


           We conducted a retrospective analysis of data obtained from the clinical records of patients admitted to Children’s Healthcare of Atlanta hospitals from March 2020 to August 2021. Study population consisted of those admitted for symptoms of acute-COVID 19 infection or patients meeting the CDC criteria for MIS-C. Cardiovascular involvement was defined by one or more of the following: elevated troponin, elevated brain natriuretic peptide (BNP), reduced ejection fraction (EF), an abnormal EKG reading, requirement of vasoactive medications, and presence of coronary dilation. Multivariable logistic regression was used to analyze associations between cardiovascular involvement and age, race/ethnicity, and comorbidities. For the MIS-C cohort, cardiovascular involvement was broken down into individual factors for analysis. The results of logistic regression analyses were expressed as crude and adjusted odds ratios (OR) and the corresponding 95% confidence intervals (CI).


           We analyzed 346 acute COVID-19 patients with median age of 8.9 years and 304 MIS-C patients with a median age of 9.1 years. Cardiovascular involvement was present in 258 MIS-C patients (84.9%) and 36 of acute COVID-19 patients (10.4%). Among acute COVID-19 patients, obesity was statistically significantly associated with cardiovascular involvement. Among MIS-C patients, statistically significant associations included obesity, age >5 years, and non-Hispanic Black race/ethnicity.


           There is a striking difference in the likelihood of cardiovascular involvement among patients with MIS-C vs. acute COVID-19 as well as statistically significant associations with obesity, race/ethnicity, and age. These results reinforce our institutional practice of following all patients with MIS-C in cardiology clinic while limiting follow up of acute COVID-19 to those with evidence of cardiovascular involvement.

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