Long-Term Cardiac and Functional Outcomes of Multisystem Inflammatory Syndrome in Children

Saturday, January 21, 2023

5:00 PM – 5:15 PM PT

Location: 308

First Author(s)

Jasmine Peng (she/her/hers)

n/a

Disclosure information not submitted.

Co-Author(s)

MC

Maria Castillo, MD

Resident Physician
Driscoll Children's Hospital
Corpus Christi,, Texas, United States

Disclosure information not submitted.
LT

Lauren Tramontano, PNP

Nurse Practitioner
Driscoll Children's Hospital
Corpus Christi,, Texas, United States

Disclosure information not submitted.
EP

Eric Purifoy, MD

Pediatric Cardiologist
Driscoll Children's Hospital
Corpus Christi,, Texas, United States

Disclosure information not submitted.
TY

Tharakanath Yarrabolu, MD

Pediatric Cardiologist
Driscoll Children's Hospital
Corpus Christi,, Texas, United States

Disclosure information not submitted.
MM

Melissa Mizesko, MD

Pediatric Rheumatologist
Driscoll Children's Hospital, United States

Disclosure information not submitted.
MH

Mary Huckabee, MD

Pediatric Hospitalist
Driscoll Children's Hospital, United States

Disclosure information not submitted.
Utpal Bhalala, MD, FCCM

Pediatric Intensivist, Associate Professor, Research Advisor
Driscoll Children's Hospital
Corpus Christi, Texas

Disclosure information not submitted.

INTRODUCTION: Multi-system Inflammatory Syndrome (MIS-C) is a hyperinflammatory state involving two or more organs associated with a previous diagnosis of SARS-CoV-2. Cardiac dysfunction is described in 80-85% of cases. Currently, there is a knowledge gap regarding long-term cardiac and functional outcomes in children diagnosed with MIS-C.

METHODS : We conducted a retrospective chart review of children < 21 years admitted to our hospital for MIS-C between January 2020 and January 2022. We collected demographic, clinical, laboratory, imaging data [left ventricular ejection fraction (LVEF), coronary artery dilation (CAD)], and functional status score (FSS) during hospital stay and long-term (up to 6 months) follow up. Using a student t-test and chi-square test, we compared the outcomes of children admitted to the pediatric intensive care unit (PICU) vs outside the PICU.

RESULTS: Out of the 40 children admitted to the hospital with MIS-C during the study period, 16 (40%) were admitted to the PICU while 24 (60%) were admitted outside the PICU. Of the PICU patients, 13.33% showed CAD and 31.25% had a LVEF ≤55% on at least one echocardiogram during their hospital stay. Of the echocardiograms completed on the non-PICU patients (n=22), 18.18% showed CAD and 9.09% had a LVEF ≤55% on at least one echo during admission. Between PICU and non-PICU patients, there was a significant (p ≤ 0.05) difference in mean length of stay (13.56 vs. 6.16 days respectively), lowest LVEF (56.14% vs 62.58%), and change in Functional Status Score (ΔFSS) (0.5 vs 0.0). Of the 16 PICU patients, 11 had follow-up echocardiogram and none had persistent CAD and/or LVEF ≤55%. Of the 20/24 (83.33%) non-PICU patients with echocardiograms at follow-up, 10% displayed persistent coronary artery dilation while none had LVEF ≤55%. At follow-up, a significant proportion of non-PICU patients had persistent CAD as compared to PICU patients (p≤0.0001), but there was no difference in LVEF and ΔFSS amongst the two cohorts.

CONCLUSIONS: A significant proportion of children admitted outside the PICU had persistent coronary abnormalities at up to 6 month follow up compared to patients admitted in the PICU. However, none of the patients had persistent low LVEF (≤55%) or functional disability at up to 6 month follow up (ΔFSS).