MIS-C and acute heart failure in children

Multisystem inflammatory syndrome in children (MIS-C) following an infection of COVID-19 or exposure to the virus has led to severe cases around the world and at least 4 deaths in the United States. A new report in Circulation examines a series of febrile patients with acute heart failure that may be tied to MIS-C and COVID-19.¹

Researchers in France and Switzerland collected clinical, biological, therapeutic, and early outcomes data for children who had been admitted to 14 pediatric intensive care units for left ventricular dysfunction, cardiogenic shock, and severe inflammatory state.

A total of 35 children were included in the study. They had a median age at admission of 10 years. Twenty-eight percent of the children had co-morbidities, which included asthma and overweight. Gastrointestinal symptoms were often seen. One third of the patients had a left ventricular eject fraction that was less than 30%. Eighty percent of the children needed inotropic support and 28% needed treatment with extracorporeal membrane oxygenation (ECMO). Markers for inflammation suggested macrophage activation (D-dimer median 5284 ng/mL) and cytokine storm (interleukin 6 median 135 pg/mL) and the mean brain natriuretic peptide was elevated. Nearly all the patients (31 of 35) tested positive for COVID-19 through polymerase chain reaction testing of a nasopharyngeal swab or serology.

All 35 children were given intravenous immunoglobulin and one-third also were given adjunctive steroid therapy. No child died. Children treated with ECMO were successfully removed from it and left ventricular function was restored for 25 of the children discharged.

References:

1.    Belhadjer Z, Méot M, Bajolle F, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation. May 17, 2020. Epub ahead of print. doi: 10.1161/CIRCULATIONAHA.120.048360