Six-Month Outcomes in the Long-Term Outcomes After the Multisystem Inflammatory Syndrome in Children Study

Dongngan T. Truong, Division of Cardiology, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City.
Felicia L. Trachtenberg, Carelon Research, Newton, Massachusetts.
Chenwei Hu, Carelon Research, Newton, Massachusetts.
Gail D. Pearson, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Kevin Friedman, Department of Cardiology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.
Arash A. Sabati, Division of Cardiology, Department of Pediatrics, University of Arizona College of Medicine and Phoenix Children's Hospital, Phoenix.
Audrey Dionne, Department of Cardiology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.
Matthew E. Oster, Children's Healthcare of Atlanta Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Brett R. Anderson, Division of Pediatric Cardiology, New York-Presbyterian/Columbia University Irving Medical Center, New York.
Joseph Block, Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee.
Tamara T. Bradford, Division of Cardiology, Department of Pediatrics, Louisiana State University and Children's Hospital of New Orleans, New Orleans.
M Jay Campbell, Division of Cardiology, Department of Pediatrics, Duke University and Duke Children's Hospital and Health Center, Durham, North Carolina.
Laura D'Addese, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, Florida.
Kirsten B. Dummer, Division of Cardiology, Department of Pediatrics, University of California-San Diego and Rady Children's Hospital, San Diego.
Matthew D. Elias, Division of Cardiology, Department of Pediatrics, University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia.
Daniel Forsha, Ward Family Heart Center, Children's Mercy Kansas City, Department of Pediatrics, University of Missouri-Kansas City, Kansas City.
Olukayode D. Garuba, Division of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Keren Hasbani, Division of Cardiology, Department of Pediatrics, University of Texas-Austin and Dell Children's Medical Center, Austin.
Kerri Hayes, Carelon Research, Newton, Massachusetts.
Camden Hebson, Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham and Children's of Alabama, Birmingham.
Pei-Ni Jone, Pediatric Cardiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora.
Anita Krishnan, Division of Cardiology, Department of Pediatrics, George Washington University and Children's National Hospital, Washington, DC.
Sean Lang, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Brian W. McCrindle, Labatt Family Heart Centre, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada.
Kimberly E. McHugh, Divsion of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston.
Elizabeth C. Mitchell, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York.
Tonia Morrison, Division of Cardiology, Department of Pediatrics, University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia.
Juan Carlos Muniz, Nicklaus Children's Hospital, Miami, Florida.
R Mark Payne, Division of Cardiology, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis.
Michael A. Portman, Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle.
Mark W. Russell, Division of Cardiology, Department of Pediatrics, University of Michigan and C.S. Mott Children's Hospital, Ann Arbor.
Yamuna Sanil, Division of Cardiology, Department of Pediatrics, Central Michigan University and Children's Hospital of Michigan, Detroit.

Document Type

Journal Article

Publication Date

1-13-2025

Journal

JAMA pediatrics

DOI

10.1001/jamapediatrics.2024.5466

Abstract

IMPORTANCE: Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening complication of COVID-19 infection. Data on midterm outcomes are limited. OBJECTIVE: To characterize the frequency and time course of cardiac dysfunction (left ventricular ejection fraction [LVEF] <55%), coronary artery aneurysms (z score ≥2.5), and noncardiac involvement through 6 months after MIS-C. DESIGN, SETTING, AND PARTICIPANTS: This cohort study enrolled participants between March 2020 and January 2022 with a follow-up period of 2 years. Participants were recruited from 32 North American pediatric hospitals, and all participants met the 2020 Centers for Disease Control and Prevention case definition of MIS-C. EXPOSURE: MIS-C after COVID-19 infection. MAIN OUTCOMES AND MEASURES: Outcomes included echocardiography core laboratory (ECL) assessments of LVEF and maximum coronary artery z scores (zMax); data collection on cardiac and noncardiac sequelae during hospitalization and at 2 weeks, 6 weeks, and 6 months after discharge; and age-appropriate Patient-Reported Outcomes Measurement Information Systems (PROMIS) Global Health Instruments at follow-up. Descriptive statistics, linear regression models, and Kaplan-Meier analysis were used. RESULTS: Of 1204 participants (median [IQR] age, 9.1 [5.6-12.7] years; 724 male [60.1%]), 325 self-identified with non-Hispanic Black race (27.0%) and 324 with Hispanic ethnicity (26.9%). A total of 548 of 1195 participants (45.9%) required vasoactive support, 17 of 1195 (1.4%) required extracorporeal membrane oxygenation, and 3 (0.3%) died during hospitalization. Of participants with echocardiograms reviewed by the ECL (n = 349 due to budget constraints), 131 of 322 (42.3%) had LVEF less than 55% during hospitalization; of those with follow-up, all but 1 normalized by 6 months. Black race (vs other/unknown race), higher C-reactive protein level, and abnormal troponin level were associated with lowest LVEF (estimate [SE], -3.09 [0.98]; R2 = 0.14; P =.002). Fifteen participants had coronary artery z scores of 2.5 or greater at any time point; 1 participant had a large/giant aneurysm. Of the 13 participants with z scores of 2.5 or greater during hospitalization, 12 (92.3%) had normalized by 6 months. Return to greater than 90% of pre-MIS-C health status (energy, sleep, appetite, cognition, and mood) was reported by 711 of 824 participants (86.3%) at 2 weeks, increasing to 548 of 576 (95.1%) at 6 months. Fatigue was the most common symptom reported at 2 weeks (141 of 889 [15.9%]), falling to 3.4% (22 of 638) by 6 months. PROMIS Global Health parent/guardian proxy median T scores for fatigue, global health, and pain interference improved significantly from 2 weeks to 6 months (fatigue, 56.1 vs 48.9; global health, 48.8 vs 51.3; pain interference, 53.0 vs 43.3; P < .001) and by the 6-week visit were at least equivalent to prepandemic population norms. CONCLUSIONS AND RELEVANCE: Results of this cohort study suggest that although children and young adults with MIS-C can have severe disease during the acute phase, most recovered quickly and had a reassuring midterm prognosis.

Department

Pediatrics

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