All right, hi, everyone. My name is Jasmine Peng, and I'm a second-year medical student, and I'm here to present our research on post-hospitalization cardiac and functional outcomes of multisystem inflammatory syndrome in children. And before I get started, I just want to thank my mentors, Dr. Balala and Dr. Yarbaloo, for guiding me through this research process, as well as the symposium coordinators for inviting me to present today, and the abstract judges for awarding me with the Star Research Achievement Award. So a little bit about me. I'm a second-year at Texas A&M School of Medicine in College Station, Texas. I'm originally from a really tiny town in central Texas called Belton, and I did my undergraduate at Cornell University in upstate New York, where I graduated in spring of 2020. This research was conducted at Driscoll Children's Hospital in Corpus Christi, Texas, under the Departments of Pediatric Cardiology and Pediatric Intensive Care, and it was funded through the MSRPP Fellows Program at Texas A&M, where I was a part of the inaugural class of fellows. And it was done under the supervision of Dr. Yarbaloo and Dr. Balala. So I have no conflicts of interest or financial disclosures. First off, a little bit of background about multisystem inflammatory syndrome in children, or MIS-C. So this is a post-COVID hyperinflammatory syndrome that is diagnosed by exclusion. And it's been recorded that up to half of the patients hospitalized for COVID-related reasons will be because of a MIS-C diagnosis. And as of October 2022, there have been about 9,000 cases with 74 deaths, as reported by the CDC. While we were looking for children to include in our cohort study, we used the inclusion and exclusion criteria as set forth by the CDC, which included children between one to 18 years old with a primary diagnosis of MIS-C, and excluded neonates as well as COVID-positive patients who did not meet the MIS-C criteria. So here's a little bit more background about the CDC's definition for MIS-C, which they say is classified by persisting fever, laboratory evidence of inflammation, so elevated inflammatory markers such as C-reactive protein, elevated white blood cell count, platelet count, fibrinogen, ferritin, et cetera, as well as multisystem involvement and evidence of clinically severe illness requiring hospitalization. So since this is a diagnosis of exclusion, one important criteria is no other plausible diagnoses, and because by definition MIS-C is a post-COVID syndrome, a recent or current positive COVID-19 test is also a requirement. So some common differentials were typhus, Kawasaki disease, and toxic shock syndrome. And since the Corpus Christi area is endemic for murine typhus, that was a common confounding diagnosis for us. So current literature on MIS-C is pretty comprehensive when it comes to acute outcomes, especially when following the hospitalization trajectory of a patient, but it's really lacking on any post-hospitalization outcomes, especially in terms of cardiac and functional outcomes. And we thought this was really important to look at, especially considering some of the cardiac sequelae were the more concerning results of MIS-C, like left ventricular dysfunction, coronary artery dilations, et cetera. And so our study aimed to bridge this literature gap by comparing both the short-term and long-term outcomes of MIS-C patients who were admitted to the PICU versus those admitted not to the PICU, outside the PICU to the general pediatric floor. And we did so by using Epic's slicer-dicer function to look for any patients with a positive MIS-C diagnosis between January 2020 and January 2022, and then looked at data points such as demographic, clinical symptomology, laboratory data, imaging from echocardiograms, as well as functional status score. And we took those data points once during hospitalization and then once at follow-up at up to six months. And then we ran a student T-test or a chi-squared test to look for significance. So this table is just going into a little bit more detail about one of the outcome measures we chose to focus on, which is functional status. And this is a validated method of measuring just any incurred disability from a hospitalization or a diagnosis. And so children are scored on a scale from one to five in six different categories. Functional status, sensory, communication, motor function, feeding, and respiratory. And so you have a maximum score of 30, which implies severe impairment, and a minimum score of six, which implies no disability. And so we wanted to see how patients' functional status changed over time. And so we took one measure at pre-admission, so before the patient was sick at all, to establish a baseline. And then took another measurement at discharge to see if there were any short-term disabilities incurred. And then we took one more measurement at follow-up, up to six months, to see if there were any persisting disability or abnormalities. So here are some results. We split our patients into two cohorts, the patients who were admitted to the PICU, which totaled 16, and the patients who were admitted not to the PICU, but to the general pediatric floor, which totaled 24 patients. And as you can see from the demographic criteria shown, age, gender, race, ethnicity, and BMI, both of these cohorts were comparable in all of those criteria. Oh, these aren't updated slides, but we also included some inflammatory markers to show like just baseline illness. And we saw a significant elevation in C-reactive protein between the PICU and non-ICU cohorts. But anyways, these are some of the other data points that we chose to look at. So average length of stay, which was significantly longer for the PICU cohort, not surprisingly. As well as lowest left ventricular ejection fraction, which was significantly lower for the PICU cohort. And the change in functional status score from baseline to discharge was higher for the PICU cohort, which implied that there was more short-term disabilities incurred in the PICU cohort than the non-ICU cohort. And the number of, the only non-significant result at discharge was the number of patients with abnormal coronary arteries, and that was comparable between the two cohorts. So at up to six-month follow-up, you can see that for the most part, any difference between the two cohorts was for the most part recovered. So that significantly lower left ventricular ejection fraction that we saw at discharge in the PICU cohort was now recovered to be more or less comparable to their non-PICU counterparts. As well as the change in functional status score from baseline to their follow-up measurement, that was also recovered to be not significantly different from their non-PICU counterparts. The only exception was the number of patients with persisting coronary artery abnormalities, and we actually found more patients in the non-PICU cohort than the PICU cohort that exhibited persisting dilated coronaries. And we think that that might be attributable to our small sample size. And then none of our patients died between discharge and follow-up in either cohort, which implies an optimistic prognosis for MIS-C. So in conclusion, at post-hospitalization follow-up, there was a significant difference in coronary artery abnormalities between the PICU versus non-PICU patients, but there was no difference in overall functional outcomes between the two cohorts. And as for future directions, I think it would be really interesting to look and see if any of these patients are at higher risk of developing a chronic autoimmune diagnosis down the line, since as we know, inflammation and autoimmune disorders often go hand-in-hand because both involve hyperactivation of the immune system. So I think it's possible that some of these patients might be at higher risk of developing like a chronic autoimmune disorder down the line, as well as I think it would be very important to follow these patients up in the more longer term, since as we've seen with other post-viral inflammatory syndromes like rheumatic fever, you sometimes see like short-term remission and then cardiac or neurological sequelae up to like 20 years down the line. So because of that, I think it's important to see whether the health statuses of these patients change at all over time. And that is all I have, so thank you guys so much for listening, and I'll take any questions.

MIS-C

cardiac outcomes

functional outcomes

coronary artery abnormalities

research