Description and outcomes of Afro-Caribbean children treated for multisystem inflammatory syndrome in the French West Indies

Charlène Grabot; Mélanie Brard; Daphnée Hilaire; Moustapha Drame; Gwladys Nadia Gbaguidi; Narcisse Elenga; Saskia Tuttle; Yves Hatchuel; Michaël Levy; Olivier Flechelles; Arthur Felix

doi:10.1016/j.heliyon.2023.e22642

Description and outcomes of Afro-Caribbean children treated for multisystem inflammatory syndrome in the French West Indies

Heliyon. 2023 Nov 19;9(12):e22642. doi: 10.1016/j.heliyon.2023.e22642. eCollection 2023 Dec.

Authors

Affiliations

¹ Pediatric Intensive Care Unit, University Hospital of Martinique, Fort-de-France, France.
² Antilles-Guyane M3C Pediatric Cardiology Center, University Hospital of Martinique, Fort-de-France, Martinique, France.
³ Department of Pediatrics, Guadeloupe University Hospital, Pointe-à-Pitre, France.
⁴ Department of Clinical Research and Innovation, Martinique University Hospital, Fort-de-France, France.
⁵ Scientific Researcher (EMERGEN Referent), Santé publique France Antilles, Guyane, France.
⁶ Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, France.
⁷ Department of General Pediatrics, Competence Center for Rheumatic, Autoimmune and Systemic diseases in Children (RAISE) Antilles-Guyane, Martinique University Hospital, Fort-de France, France.
⁸ Pediatric Intensive Care Unit, University Hospital Robert-Debré, Paris Cité University, Paris, France.
⁹ Department of Pediatrics, Reference Center for RAISE, University Hospital Robert-Debré, Paris, France.

Abstract

Introduction: Several studies have reported a higher frequency and greater morbidity and mortality of multisystem inflammatory syndrome in children (MIS-C) of black African descent.

Objectives: We aimed to describe the clinical, laboratory and echocardiographic characteristics as well as outcomes of children with MIS-C requiring admission to a pediatric intensive care unit (PICU) in the French West Indies (FWI), where the majority of the population is Afro-Caribbean.

Methods: Ambidirectional observational cohort study between April 1, 2020 and August 31, 2022. Children (age ≤18 years) with MIS-C and organ failure were included. Every patient was monitored and treated following the same protocol, with repeated biological tests, echocardiography, intravenous steroids and polyvalent immunoglobulins. The primary outcomes were clinical, laboratory and echocardiography characteristics.

Results: Forty children (median age 7 years, range: 5-11) were included. The majority (77 %) were included prospectively. Thirty-five (87 %) had gastrointestinal symptoms, 30 (75 %) presented initial heart failure (with persisting diastolic dysfunction at day 7) and 18 (45 %) had pericarditis. Sixteen (40 %) were in cardiogenic shock and required inotropic support. Median duration of inotropic support and hospitalization in PICU were respectively 4 and 5 days. The evolution curves of the inflammatory variables matched after treatment. The clinical outcomes were favorable. The Delta variant was associated with the highest incidence of MIS-C.

Conclusion: This is the first description of MIS-C course among children of Afro-Caribbean descent. The outcomes were good, without any death or cardiac sequelae. Our work does not support an ethnic susceptibility for severity of MIS-C in Afro-Caribbean population.

Keywords: Acute heart failure; Adolescent; Child; Echocardiography; Multisystem inflammatory syndrome in children; Pediatric intensive care unit; SARS-CoV-2.