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Auger N, Côté-Corriveau G, Kang H, Quach C, Lo E, Lee GE, Healy-Profitós J, Brousseau É, Luu TM. Multisystem inflammatory syndrome in 1.2 million children: longitudinal cohort study of risk factors. Pediatr Res 2024; 95:325-333. [PMID: 37198405 PMCID: PMC10191400 DOI: 10.1038/s41390-023-02633-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND We identified patient characteristics associated with an increased risk of developing MIS-C. METHODS We conducted a longitudinal cohort study of 1,195,327 patients aged 0-19 years between 2006 and 2021, including the first two waves of the pandemic (February 25-August 22, 2020 and August 23, 2020-March 31, 2021). Exposures included prepandemic morbidity, birth outcomes, and family history of maternal disorders. Outcomes included MIS-C, Kawasaki disease, and other Covid-19 complications during the pandemic. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for the association between patient exposures and these outcomes using log-binomial regression models adjusted for potential confounders. RESULTS Among 1,195,327 children, 84 developed MIS-C, 107 Kawasaki disease, and 330 other Covid-19 complications during the first year of the pandemic. Prepandemic hospitalizations for metabolic disorders (RR 11.3, 95% CI 5.61-22.6), atopic conditions (RR 3.34, 95% CI 1.60-6.97), and cancer (RR 8.11, 95% CI 1.13-58.3) were strongly associated with the risk of MIS-C, compared with no exposure. These same exposures were also associated with Kawasaki disease and other Covid-19 complications. However, birth characteristics and history of maternal morbidity were not associated with MIS-C development. CONCLUSIONS Children with pre-existing morbidity have a considerably elevated risk of MIS-C. IMPACT Morbidities that predispose children to multisystem inflammatory syndrome (MIS-C) are unclear. In this study, prepandemic hospitalizations for metabolic disorders, atopic conditions, and cancer were associated with an elevated risk of MIS-C. Birth characteristics and family history of maternal morbidity were not, however, associated with MIS-C. Pediatric morbidities may play a greater role in MIS-C onset than maternal or perinatal characteristics, and may help clinicians better recognize children at risk for this complication.
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Affiliation(s)
- Nathalie Auger
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada.
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Gabriel Côté-Corriveau
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Harb Kang
- Department of Rheumatology, Cité-de-la-Santé Hospital, Laval, QC, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal, QC, Canada
- Infection Prevention and Control, Clinical Department of Laboratory Medicine, Sainte-Justine Hospital Research Centre, Montreal, QC, Canada
| | - Ernest Lo
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Ga Eun Lee
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Jessica Healy-Profitós
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Émilie Brousseau
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, QC, Canada
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Kats DJ, Martin SD, Smith MH. Do not "MIS-C" the cancer: A case report of balancing the timing of concurrent treatment for MIS-C and incidentally diagnosed pediatric Wilms tumor. Pediatr Blood Cancer 2023; 70:e30216. [PMID: 36751110 DOI: 10.1002/pbc.30216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/28/2022] [Accepted: 01/04/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Daniel J Kats
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samantha D Martin
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mariel H Smith
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Pediatric Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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