Researchers identify attributes that may differentiate MIS-C from COVID-19


February 24, 2021

3 min read

Feldstein reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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A study involving more than 1,000 patients identified cardiac involvement, age and race as attributes that could differentiate multisystem inflammatory syndrome in children from severe COVID-19, researchers reported in JAMA.

CDC epidemiologist Leora R. Feldstein, PhD, and colleagues conducted a case series that included 1,116 patients aged younger than 21 years from the Overcoming COVID-19 network who were hospitalized in 31 states from March 15 through Oct. 31 — 539 (48%) with MIS-C and 577 (52%) with acute COVID-19.

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Of those with MIS-C, 52% had a positive reverse transcriptase PCR test for SARS-CoV-2, 45% were positive only for antibodies, 31% were positive for both and 19% did not have an antibody test performed, Feldstein and colleagues reported.

Among presenting symptoms and signs, they found that only mucocutaneous findings differed in its prevalence, appearing in 66.8% (95% CI, 63%-71%) of patients with MIS-C vs. 10.2% (95% CI, 8%-13%) of patients with COVID-19.

Cardiac involvement was more common among participants with MIS-C (66.7%; 95% CI, 63%-71%) vs. COVID-19 (11.8%; 95% CI, 9%-15%). In both cohorts, 80% of patients had severe respiratory involvement.

Additionally, patients diagnosed with MIS-C were more likely to be aged 6 to 12 years (40.8% vs 19.4%; risk difference [RD] = 21.4% [95% CI, 16.1%-26.7%]); be Black (32.3% vs. 21.5%; RD = 10.8% [95% CI, 5.6%-16%]) and have no underlying conditions (69% vs 37.9%; RD = 31.1% [95% CI, 25.5%-36.6%]).

Following an adjustment for covariates, the authors reported that the risk for MIS-C was higher for those aged 6 to 12 years compared with those aged 0 to 5 years (aRR, 1.51; 95% CI, 1.33-1.72), as well as patients who were Black compared with those who were white (adjusted RR, 1.43; 95% CI, 1.17-1.76).

Additionally, patients with MIS-C were more likely to have cardiorespiratory involvement compared with those with COVID-19 (56% vs 8.8%; RD = 47.2; 95% CI, 42.4%-52%), cardiovascular without respiratory involvement (10.6% vs 2.9%; RD = 7.7%; 95% CI, 4.7%-10.6%), and mucocutaneous without cardiorespiratory involvement (7.1% vs 2.3%; RD = 4.8%; 95% CI, 2.3%-7.3%).

An MIS-C diagnosis also was more likely in patients with cardiorespiratory involvement compared with patients with respiratory involvement alone (aRR = 2.99; 95% CI, 2.55-3.5) and mucocutaneous without cardiorespiratory involvement (aRR = 2.29; 95% CI, 1.84-2.85).


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