MIS-C is more common and more severe than previously reported, the study found

MIS-C is more common and more severe than previously reported, the study found

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Although still rare, post-Covid-19 MIS-C is more common and more severe than previously reported, and there are significant racial disparities in cases, according to a study published Thursday in JAMA Network Open.

Multisystem inflammatory syndrome in children – which mainly occurs after infection with Covid-19 – causes inflammation in different parts of the body and can affect major organs, including the kidneys, brain, lungs and heart. It can be serious or fatal.

The US Centers for Disease Control and Prevention currently relies on voluntary case reporting by local health departments for MIS-C surveillance. In November, they have entered a total of about 9,000 cases and 74 deaths from MIS-C out of the millions of Covid-19 cases among children.

In 2021, an official diagnosis code for MIS-C was created, and the new study analyzed records collected by the Agency for Healthcare Research and Quality from thousands of hospitals representing more than three-quarters of the US population.

It found that for every 100 children hospitalized with Covid-19 in 2021, there were about 17 MIS-C hospitalizations. MIS-C hospitalizations tended to be younger and more likely to occur in male children than Covid-19 hospitalizations.

The more organs affected, the worse the results. As the number of affected organ systems increased from two to six or more, the death rate increased from 1% to 6%, according to the new study. Length of hospital stay doubled from four to eight days, and adverse drug reactions more than tripled from 5% to 18%.

Overall, more than 60% of children hospitalized with MIS-C had more than two organ systems affected. Of these, about 8% of patients had at least six organ systems affected.

Racial disparities in Covid-19 outcomes are well established, and this new study found even greater disparities in MIS-C outcomes.

MIS-C hospitalizations were twice as likely among black children as among white children. And while black children account for about 24 percent of all MIS-C cases, they account for 32 percent of the most severe cases, which affect at least six organ systems.

The researchers also found that “the severity of MIS-C for black children was likely exacerbated by socioeconomic factors,” with those living in the most socially vulnerable communities typically spending an extra day in the hospital. They did not find the same relationship for hospitalizations with Covid-19.

These findings “increase our knowledge of MIS-C and COVID-19 discrepancies and outcomes, shedding light on the risks and impacts of increasing organ system dysfunction,” according to a study commentary by pediatricians and researchers at the University of Colorado School of Medicine.

But they raise even more critical questions, including specific reasons for the vast racial disparities.

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