1. Children with MIS-C had higher titers of SARS- CoV-2 antibodies compared to patients with Kawasaki disease, COVID-19, and hospitalized controls.
2. Levels of SARS-CoV-2 antibodies correlated with higher erythrocyte sedimentation rate (ESR) and length of hospital and ICU stay
Evidence Rating Level: 2 (Good)
Study Rundown: Although the majority of children with COVID-19 have mild symptoms, some children develop a severe condition several weeks after the initial infection, termed multisystem inflammatory syndrome in children (MIS-C). This study aimed to characterize SARS-CoV-2 serology in hospitalized patients with MIS-C at a children’s hospital in Atlanta. Researchers found that children with MIS-C had higher SARS-CoV-2 antibodies than those with COVID-19, Kawasaki disease (KD), and hospitalized controls. Higher levels of antibodies were associated with elevated ESR and prolonged length of hospital and ICU admission. While the widespread applicability of the study is limited by its small sample size, these findings may have diagnostic and prognostic value in MIS-C risk stratification and distinguishing it from other similar diseases.
In-Depth [prospective cohort]: Twenty-nine children hospitalized at Children’s Healthcare of Atlanta between March 17th through May 26th were enrolled in this prospective study. They were divided into four groups; those with MIS-C (n=10), those with COVID-19 (n=10), those with KD (n=5), and hospitalized controls (n=4). Those in the MIS-C group had significantly higher SARS-CoV-2 receptor-binding domain (RBD) IgG titers and full-length spike and nucleocapsid protein antibody titers than the other groups (p < 0.001 for each comparison). The MIS-C group also had higher SARS CoV-2 neutralizing antibody titers than children with COVID-19 (p = 0.006), children with KD (p = 0.001), and hospitalized controls (p = 0.002). Linear regression analysis showed that RBD IgG antibody titers had a positive correlation with peak ESR values (n = 8, r2 = 0.512, p = 0.046), total hospital length of stay (n = 10, r2= 0.548, p = 0.014), and ICU length of stay (n = 10, r2= 0.590, p = 0.010). There was no correlation with CRP levels (r2= 0.026, p = 0.655).
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