Long−term health outcome and quality of life in children with multisystem inflammatory syndrome: findings from multidisciplinary follow−up at an Italian tertiary−care paediatric hospital
Authors: D’Auria Enza , Bova Stefania Maria , Dallapiccola Andrea Riccardo , De Santis Raffaella , Leone Alessandro , Calcaterra Valeria , Mannarino Savina , Garbin Massimo , Olivotto Sara , Zirpoli Salvatore , Ghezzi Michele , Munari Alice Marianna , Verduci Elvira , Farolfi Andrea , Bosetti Alessandra , Perico Veronica , Capetti Pietro , Gadda Arianna , Gianolio Laura , Lo Monaco Germana , Lonoce Luisa , Previtali Roberto , Serafini Ludovica , Taranto Silvia , Veggiotti Pierangelo , Zuccotti Gianvincenzo 
Published: September 2024

Multisystem inflammatory syndrome is a severe complication of SARS-CoV-2 infection in children (MIS-C). To date, data on long-term sequelae mainly concern cardiac outcomes. All ≤ 18 year olds consecutively admitted to the Buzzi Children’s Hospital with a diagnosis of MIS-C between October 1, 2020, and May 31, 2022, were followed up for up to 12 months by a dedicated multidisciplinary team. They underwent laboratory tests, multi-organ clinical and instrumental assessments, and psychosocial evaluation. 56/62 patients, 40 M, mean age 8.7 years (95% CI 7.7, 9.7), completed the follow-up. Cardiological, gastroenterological, pneumological, and neurological evaluations, including IQ and EEG, were normal. Alterations of HOMA-IR index and/or TyG index, observed in almost all patients during hospitalisation, persisted in about a third of the population at 12 months. At 6 and 12 months respectively, impairment of adaptive functions was observed in 38/56 patients (67.9%) and 25/56 (44.6%), emotional and behavioural problems in 10/56 (17.9%) and 9/56 (16.1%), and decline in QoL in 14/56 (25.0%) and 9/56 (16.1%). Psychosocial well-being impairment was significantly more frequent in the subgroup with persistent glycometabolic dysfunction at 12 months (75% vs. 40.9% p < 0.001).

Conlusion: The mechanisms that might explain the long-term persistence of both metabolic alterations and neuro-behavioural outcomes and their possible relationship are far from being clarified. Our study points out to the potential long-term effects of pandemics and to the importance of a multidisciplinary follow-up to detect potential negative sequelae in different areas of health, both physical and psychosocial.

What is known:• Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infection.• Few data exist on the medium- and long-term outcomes of MIS-C, mostly focused on cardiac involvement. Emerging evidence shows neurological and psychological sequelae at mid- and long-term follow-up.

What is new:• This study reveals that MIS-C may lead to long-term glycometabolic dysfunctions joined to impairment in the realm of general well-being and decline in quality of life, in a subgroup of children.• This study highlights the importance of a long-term multidisciplinary follow-up of children hospitalised with MIS-C, in order to detect the potential long-term sequelae in different areas of health, both physical and psychosocial well-being.