5 - Hepatic involvement is associated with increased mortality in pediatric patients with MIS-C associated with COVID-19 infection.

Poster Number: 5
Publication Number: 5.207

Aravind Thavamani, UH Rainbow Babies and Children's Hospital/ Case Western Reserve University/, Cleveland, OH, United States; Jasmine Khatana, Metrohealth-Case Western Reserve Univ, Cleveland, OH, United States; Thomas J. Sferra, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Senthilkumar Sankararaman, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States

Background: Hepatic involvement is increasingly reported in patients who develop multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, however its clinical implications are unknown. 

Objective: To evaluate the impact of hepatic involvement among patients with COVID-19 related MISC on inhospital mortality and length of stay

Design/Methods: We analyzed the PHIS database from January 1, 2020 to October 31st, 2021 to include all patients up to 21 years of age with a diagnosis of MIS-C using the International Classification of Diseases (ICD) code. We excluded patients with preexisting hepatic involvement such as NASH and chronic hepatitis viral infections. Patients were analyzed for the presence of hepatitis using the ICD codes and were compared for various demographic factors, involvement of other systems, resource utilization including the need for ICU care, and utilization of mechanical ventilation, ECMO and parenteral nutrition. The primary outcome was mortality and among survivors, we compared the length of stay between the groups.

Results: We analyzed a total of 3061 patients with MIS-C during the study period and 11% (336) had hepatitis. MIS-C patients with hepatitis were significantly older (9.9 vs 8.6 years), more often males and had public insurance. No racial differences were noted. MIS-C patients with hepatitis has significantly increased proportion of gastrointestinal involvement including vomiting, diarrhea and abdominal pain. The prevalence rate of hypotension was significantly higher among those with hepatitis. However, cardiac involvement was not significantly different between the groups. The overall mortality rate was 0.9% but was significantly higher in group with hepatitis (3.3% vs 0.6%), P< 0.001. MIS-C patients with hepatitis had increased need for ICU admission, mechanical ventilation and ECMO. After adjusting for other system involvement and intensive care management, regression analysis showed that hepatitis was associated with 3 times increased odds of mortality (95% CI:1.2 to 7.4, P=0.01) among patients with MIS-C. Among survivors, patients with hepatitis had significantly prolonged hospitalization compared to controls (5.7 vs 4.7 days, P=0.004). Conclusion(s): MIS-C patients with hepatitis involvement had significantly increased disease burden with need for more ICU care, mechanical ventilation and also had adverse outcomes resulting in increased mortality and prolonged hospitalization. Further studies are needed to better elucidate the pathophysiology of hepatic involvement in MIS-C to improve outcomes.
Aravind CVCV 2021.pdf