• Joanna Merckx, Suzette Cooke, Tala El Tal, Ari Bitnun, Shaun K Morris, YehE AnnEADepartment of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Mor, Carmen Yea, Peter Gill, Jesse Papenburg, Marie-Astrid Lefebvre, Rosie Scuccimarri, Rolando Ulloa-Gutierrez, Helena Brenes-Chacon, Adriana Yock-Corrales, Gabriela Ivankovich-Escoto, Alejandra Soriano-Fallas, Marcela Hernandez-de Mezerville, Tammie Dewan, Lea Restivo, Alireza Nateghian, Behzad Haghighi Aski, Ali Manafi, Rachel Dwilow, Jared Bullard, Alison Lopez, Manish Sadarangani, Ashley Roberts, Michelle Barton, Dara Petel, Nicole Le Saux, Jennifer Bowes, Rupeena Purewal, Janell Lautermilch, Sarah Tehseen, Ann Bayliss, Jacqueline K Wong, Kirk Leifso, Cheryl Foo, Joan Robinson, and Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC).
• Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta.
• CMAJ. 2022 Apr 11; 194 (14): E513-E523.

BackgroundSARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time.MethodsWe obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement.ResultsOf 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13-17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6-12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 μg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI -0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%).InterpretationWe observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined.© 2022 CMA Impact Inc. or its licensors.

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