Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study()()()

Lima-Setta, Fernanda; Magalhães-Barbosa, Maria Clara de; Rodrigues-Santos, Gustavo; Figueiredo, Elaine Augusta das Neves; Jacques, Melissa de Lorena; Zeitel, Raquel de Seixas; Sapolnik, Roberto; Borges, Cibelle Teixeira da Siva; Lanziotti, Vanessa Soares; Castro, Roberta Esteves Vieira de; Bellinat, Ana Paula Novaes; Silva, Thiago Peres da; Oliveira, Felipe Rezende Caino de; Reis, Bárbara Carvalho Santos dos; Castro, Natália Almeida de Arnaldo Silva Rodriguez; Macedo, João Henrique Garcia Cobas; Scarlato, Ana Carolina Cabral Pinheiro; Riveiro, Paula Marins; Mota, Isabele Coelho Fonseca da; Lorenzo, Vivian Botelho; Lucena, Natalia Martins Lima de; Azevedo, Zina Maria Almeida de; Cunha, Antonio José L.A.; Prata-Barbosa, Arnaldo

OBJECTIVE: To describe the clinical, laboratory, and radiological characteristics, as well as the outcomes of children with MIS-C. METHOD: Multicenter, prospective cohort study, conducted in 17 pediatric intensive care units in five states in Brazil, from March to July 2020. Patients from 1 month to 19 years who met the MIS-C diagnostic criteria were included consecutively. RESULTS: Fifty-six patients were included, with the following conditions: Kawasaki-like disease (n = 26), incomplete Kawasaki disease (n = 16), acute cardiac dysfunction (n = 10), toxic shock syndrome (n = 3), and macrophage activation syndrome (n = 1). Median age was 6.2 years (IQR 2.4-10.3), 70% were boys, 59% were non-whites, 20% had comorbidities, 48% reported a contact with COVID-19 cases, and 55% had a recent SARS-CoV-2 infection confirmed by RT-PCR and/or serology. Gastrointestinal symptoms were present in 71%, shock symptoms in 59%, and severe respiratory symptoms in less than 20%. D-dimer was increased in 80% and cardiac dysfunction markers in more than 75%. Treatment included immunoglobulin (89%); corticosteroids, antibiotics, and enoxaparin in about 50%; and oseltamivir and antifungal therapy in less than 10%. Only 11% needed invasive mechanical ventilation, with a median duration of five days (IQR 5-6.5). The median length of PICU stay was six days (IQR 5-11), and one death occurred (1.8%). CONCLUSIONS: Most characteristics of the present MIS-C patients were similar to that of other cohorts. The present results may contribute to a broader understanding of SARS-CoV-2 infection in children and its short-term consequences. Long-term multidisciplinary follow-up is needed, since it is not known whether these patients will have chronic cardiac impairment or other sequelae.