Severe gastrointestinal involvement in children with SARS-CoV-2 infection and multisystem inflammatory syndrome

1. In this cohort study of children with SARS-CoV-2 infection and multisystem inflammatory syndrome, approximately 1 in 10 children developed severe gastrointestinal manifestations requiring hospitalization and intensive care unit admission.

2. Awareness of the factors associated with severe gastrointestinal manifestations may help clinicians identify children predisposed to these diagnoses and manage those at risk for severe outcomes.

Evidence Rating Level: 2 (Good)

Study Rundown: The incidence of gastrointestinal (GI) manifestations in patients with SARS-CoV-2 infection varies with age, underlying comorbidities, and environment, where children are more likely to present with GI symptoms than adults. However, their frequency and clinical outcome are unknown. This multicenter cohort study investigated the clinical, radiological, and histopathologic characteristics of children with acute SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C), with the aim of identifying factors associated with severe GI manifestations. The primary outcome was occurrence of severe GI manifestations, including acute abdomen, appendicitis, intussusception, pancreatitis, abdominal fluid collection, and diffuse adenomesenteritis, occurring during or within 4 to 6 weeks after SARS-CoV-2 infection. Among 685 Italian children with SARS-CoV-2 infection or MIS-C, 10% showed severe GI involvement, where children older than 5 years and those presenting with abdominal pain, leukopenia, or receiving a diagnosis of MIS-C were more likely to have severe GI manifestations. Being aware of the factors associated with severe GI manifestations may help clinicians identify children with these diagnoses and manage those at risk for severe outcomes. A limitation of this study was the absence of key information on timing of clinical findings and laboratory tests from the case report form, resulting in confounding of markers and estimators of probability for severe outcomes associated with infection.

Click to read the study in JAMA Network Open

Relevant Reading: SARS-CoV-2 and the gastrointestinal tract in children

In-Depth [retrospective cohort]: This multicenter cohort study included 685 children (median age [IQR], 7.3 [1.6-12.4] years; 386 [56.4%] boys) with acute SARS-CoV-2 infection or fulfilling the US Centers for Disease Control and Prevention criteria for MIS-C. The study was conducted in Italy between February 2020 to January 2021. In total, 628 (91.7%) children were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C, where 65 children (9.5%) showed severe GI involvement, including disseminated adenomesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6%) and 27 (41.5%) underwent surgery. The presence of GI symptoms was associated with a higher risk of hospitalization (OR, 2.64; 95%CI, 1.89-3.69) and intensive care unit admission (OR, 3.90; 95%CI, 1.98–7.68). Severe GI manifestations were associated with the child’s age (5-10 years: OR, 8.33; 95%CI, 2.62-26.5; >10 years: OR, 6.37; 95%CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95%CI, 10.1-118), lymphopenia (aOR, 8.93; 95%CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95%CI, 1.92-20.5).

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