New study identifies key demographic, clinical and biomarker characteristics of MIS-C patients
Multisystem inflammatory syndrome in children (MIS-C) significantly affected more black and Latino children than white children, black children being the most at risk, according to a new observational study of 124 pediatric patients treated at Children’s National Hospital in Washington, DC Researchers also found that heart complications, including systolic myocardial dysfunction and valve regurgitation, were more common in MIS-C patients who were critically ill. Of the 124 patients, 63 were eventually diagnosed with MIS-C and were compared to 61 patients considered to be controls who had similar symptoms but ultimately had an alternative diagnosis.
In the study published in The Journal of Pediatrics, the researchers provide an overview of the main characteristics distinguishing MIS-C patients to provide a more realistic picture of the disease burden in the pediatric population and to aid in early detection of disease and treatment for optimal outcomes. COVID-related syndrome has affected nearly 4,000 children in the United States in the past year. The first reports showed serious illness, substantial variation in treatment, and mortality associated with MIS-C. However, this study demonstrated that with early recognition and standardized treatment, short-term mortality can be almost eliminated.
“Data like this will be essential for the development of clinical trials on the long-term implications of MIS-C,” says Dr Roberta DeBiasi, MD, senior author and head of the division of pediatric infectious diseases at Children’s National . “Our study sheds light on the demographic, clinical and biomarker characteristics of this disease, as well as viral load and viral sequencing.”
Of the 63 children with MIS-C, 52% were critically ill, and additional subtypes of MIS-C were identified, including those with and without still detectable virus, those with and without characteristics that met criteria for the disease. from Kawasaki, and those with or without detectable viruses. heart abnormalities. While the median age (7.25 years) and sex were similar between the MIS-C cohort and the control group, black (46%) and Latino (35%) children were over-represented in the MIS-C group, especially those who required intensive care. Heart complications were also more common in children who became seriously ill with MIS-C (55% vs. 28%). The results also showed that MIS-C patients exhibited a distinct cytokine signature, with significantly higher levels of certain cytokines than those of controls. This can help to understand what motivates the condition and what potential treatments may be most effective.
By examining viral load and antibody biomarkers, researchers found that cases of MIS-C with a detectable virus had a lower viral load than cases of primary infection with SARS-CoV-2, but similar to MIS-C controls which had alternative diagnoses, but which also had detectable viruses. A greater proportion of patients with MIS-C had detectable SARS-CoV-2 antibodies than controls. This is consistent with current thinking that MIS-C occurs weeks after a primary infection with COVID-19 as part of an overzealous immune response.
Viral sequencing was also performed in the MIS-C cohort and compared to cases of primary COVID-19 infection in the national geographic population of children. 88% of the samples analyzed fell into the GH clade, which corresponds to the high frequency of the GH clade circulating earlier in the pandemic in the United States and Canada, and observed for the first time in France.
“The fact that there were no notable sequencing differences between our MIS-C and the primary COVID cohorts suggests that variations in host genetics and / or immune response are more likely determinants primary factors of how MIS-C presents itself, rather than virus-specific factors, “says Dr. DeBiasi.” As we have seen new variants continue to emerge, it will be important to study their effect on frequency and severity of MIS-C. “
Researchers are still looking for a consensus on the most effective treatments for MIS-C. In a recent editorial by New England Journal of MedicineDr DeBiasi calls for large, well-characterized prospective cohort studies in single centers and for systematic, long-term follow-up of cardiac and non-cardiac outcomes in children with MIS-C. Data from these studies will be a crucial determinant of the best set of treatment guidelines for immunotherapies to treat MIS-C.
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