Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19
Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19
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DOI：
10.1001/jama.2021.2091
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发表时间：
2021-02-24
影响因子：
120.7
通讯作者：
Randolph, Adrienne G.
中科院分区：
文献类型：
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作者：
Feldstein, Leora R.;Tenforde, Mark W.;Randolph, Adrienne G.
重要性：改进儿童多系统炎症综合征（MIS-C）的标准可能有助于改善健康结果。目的比较儿童和青少年misc与2019年严重冠状病毒病（COVID-19）的临床特征和结局。背景、设计和参与者：2020年3月15日至10月31日期间，在美国31个州的66家医院住院的1116名21岁以下患者的病例系列。最终随访日期为2021年1月5日。misc患者有发热、炎症、多系统受累、严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）逆转录聚合酶链反应（RT-PCR）或抗体检测阳性或近期暴露，无其他诊断。新冠肺炎患者RT-PCR检测结果阳性，器官系统严重受累。曝光SARS-CoV-2。出现症状、器官系统并发症、实验室生物标志物、干预措施和临床结果。采用多变量回归计算与MIS-C和COVID-19相关因素的调整风险比（aRRs）。结果1116例患者（中位年龄9.7岁，女性4.5%）中，539例（48%）诊断为misc， 577例（52%）诊断为COVID-19。与COVID-19患者相比，MIS-C患者更可能发生在6 - 12岁(40.8% vs 19.4%；绝对风险差[RD]， 21.4% [95% CI, 16.1%-26.7%]；aRR, 1.51[95% Cl, 133-1.72] vs 0-5岁)和非西班牙裔黑人（32.3% vs 21.5%； RD, 10.8% [95% CI, 5.6%16.0%]; aRR, 1.43 [95% CI, 1.17-1.76] vs白人）。与COVID-19患者比较。MIS-C患者更有可能发生心肺受累（56.0% vs 8.8%； RD, 47.2% [95% CI, 42.4%-52.0%）；aRR, 2.99 [95% CI, 235-3.50] vs呼吸受累)，心血管无呼吸受累(10.6% vs 2.9%； RD, 7.7% [95% CI]。4.7% - -10.6%);aRR, 2.49 [95% CI, 2.05-3.02] vs呼吸受累)和粘膜皮肤无心肺受累（7.1% vs 2.3%； RD, 4.8% [95% CI, 23%-73%）；aRR, 2.29 [95% CI, 1.84-2.85] vs呼吸受累)。MIS-C患者中性粒细胞与淋巴细胞之比较高（中位数，6.4 vs 2.7, P < 0.001）， c反应蛋白水平较高（中位数，152 mg/L vs 33 mg/L, P < 0.001），血小板计数较低(
IMPORTANCE Refinement of criteria for multisystem inflammatory syndrome in children (MIS-C) may inform efforts to improve health outcomes.OBJECTIVE To compare clinical characteristics and outcomes of children and adolescents with MIS-C vs those with severe corona virus disease 2019 (COVID-19).SETTING, DESIGN, AND PARTICIPANTS Case series of 1116 patients aged younger than 21 years hospitalized between March 15 and October 31, 2020, at 66 US hospitals in 31 states. Final date of follow-up was January 5, 2021. Patients with MIS-C had fever, inflammation, multisystem involvement, and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) or antibody test results or recent exposure with no alternate diagnosis. Patients with COVID-19 had positive RT-PCR test results and severe organ system involvement.EXPOSURE SARS-CoV-2.MAIN OUTCOMES AND MEASURES Presenting symptoms, organ system complications, laboratory biomarkers, interventions, and clinical outcomes. Multivariable regression was used to compute adjusted risk ratios (aRRs) of factors associated with MIS-C vs COVID-19.RESULTS Of 1116 patients (median age, 9.7 years; 4.5% female), 539 (48%) were diagnosed with MIS-C and 577 (52%) with COVID-19. Compared with patients with COVID-19, patients with MIS-C were more likely to be 6 to 12 years old (40.8% vs 19.4%; absolute risk difference [RD], 21.4% [95% CI, 16.1%-26.7%); aRR, 1.51[95% Cl, 133-1.72] vs 0-5 years) and non-Hispanic Black (32.3% vs 21.5%; RD, 10.8% [95% CI, 5.6%16.0%]; aRR, 1.43 [95% CI, 1.17-1.76] vs White). Compared with patients with COVID-19. patients with MIS-C were more likely to have cardiorespiratory involvement (56.0% vs 8.8%; RD, 47.2% [95% CI, 42.4%-52.0%); aRR, 2.99 [95% CI, 235-3.50] vs respiratory involvement), cardiovascular without respiratory involvement (10.6% vs 2.9%; RD, 7.7% [95% CI. 4.7%-10.6%); aRR, 2.49 [95% CI, 2.05-3.02] vs respiratory involvement), and mucocutaneous without cardiorespiratory involvement (7.1% vs 2.3%; RD, 4.8% [95% CI, 23%-73%); aRR, 2.29 [95% CI, 1.84-2.85] vs respiratory involvement). Patients with MIS-C had higher neutrophil to lymphocyte ratio (median, 6.4 vs 2.7, P < .001), higher C-reactive protein level (median, 152 mg/L vs 33 mg/L; P < .001), and lower platelet count (