- Multisystem inflammatory syndrome in children (MIS-C), a delayed hyperinflammatory response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is an important cause of illness in children.
The authors studied the association between changes in prevalent SARS-CoV-2 variants and the clinical presentation and outcomes of Multisystem inflammatory syndrome in children (MIS-C). They used data from the International Kawasaki Disease Registry (IKDR) and stratified patients according to the periods defined by the predominant locally circulating ancestral or variant lineages. The study enrolled 2017 patients, and patients during the delta and omicron periods were younger, showed greater phenotypic similarity to patients with Kawasaki’s disease, and had a lower incidence of respiratory dysfunction and coronary-artery dilatation than patients during the ancestral and alpha+ periods. Immunomodulatory management evolved to include greater use of glucocorticoids, and the risks of serious complications, admission to an intensive care unit, and death decreased, with the most pronounced decrease during the omicron period. The features of MIS-C at presentation were more often similar to the features of Kawasaki’s disease among patients hospitalized with SARS-CoV-2 infection during the more recent variant periods than among those during the earlier periods. However, severe disease was still prevalent, with 23% of the patients during the omicron period presenting with shock and with 37% being admitted to an intensive care unit.
| Safety Outcomes | Percentage |
|---|---|
| Risk of ventricular dysfunction (alpha+ period) | 35% |
| Risk of ventricular dysfunction (ancestral period) | 28% |
| Prevalence of shock (omicron period) | 23% |
| Admitted to intensive care unit (omicron period) | 37% |
Key findings:
- Patients during the delta and omicron periods had a lower incidence of respiratory dysfunction and coronary-artery dilatation than patients during the ancestral and alpha+ periods.
- Immunomodulatory management evolved to include greater use of glucocorticoids, and the risks of serious complications, admission to an intensive care unit, and death decreased, with the most pronounced decrease during the omicron period.
- The features of MIS-C at presentation were more often similar to the features of Kawasaki’s disease among patients hospitalized with SARS-CoV-2 infection during the more recent variant periods than among those during the earlier periods.
- Severe disease was still prevalent, with 23% of the patients during the omicron period presenting with shock and with 37% being admitted to an intensive care unit.
McCrindle, B. W., Harahsheh, A. S., Handoko, R., Raghuveer, G., Portman, M. A., Khoury, M., Newburger, J. W., Lee, S., Jain, S. S., Khare, M., Dahdah, N., & Manlhiot, C. (2023). SARS-CoV-2 Variants and Multisystem Inflammatory Syndrome in Children. New England Journal of Medicine, 388(17), 1624-1626.