Pediatric Transplantation

Acute Hepatitis Is a Prominent Presentation of Multisystem Inflammatory Syndrome in Children (MIS-C): A Single-Center Report

    A newly recognized multisystem inflammatory syndrome in children (MIS-C) has a paradigm-shifting effect on the perception of severe acute respiratory syndrome, coronavirus-2 (SARS-CoV-2) illness severity in children. Mercedes Martinez, MD, Medical Director for Pediatric Abdominal Organ Transplantation at NewYork-Presbyterian’s Center for Liver Disease and Transplantation, together with other researchers at Columbia University including Amanda Cantor, MD, Jonathan Miller, MD, Philip Zachariah, MD, Bernardo DaSilva, and Kara Margolis, MD, report the clinical and biochemical features of liver involvement and the comorbidities that present with hepatitis in a substantial cohort of patients.

    • In the retrospective cohort study of 44 patients with MIS-C admitted at NewYork-Presbyterian Morgan Stanley Children's Hospital during April and May 2020, researchers evaluated the number of patients who developed hepatitis and examined both demographics and inflammatory laboratory values to ascertain those that were at higher risk for liver involvement and more severe disease.
    • The study found hepatitis was present in 19 subjects (43%) and was associated with more severe disease. Individuals with hepatitis had significantly higher rates of shock at presentation (21.1% vs. 0%, p=0.008), greater respiratory support requirement (42.1% vs. 12%, p=0.005), and longer hospitalization times (median 7-days [IQR5,10] vs 4-days [IQR3.5,6.5], p<0.05).
    • More severe disease was seen in the cohort with hepatitis, compared to those without, based on notable differences in laboratory values. Patients with hepatitis had significantly higher levels of ferritin (706.9 vs. 334.2 mg/mL, p<0.01), Interleukin-6 (233.9 vs. 174.7 pg/mL, p<0.05), troponin (83 vs. 28.5 ng/L, p<0.05) and B-type Natriuretic peptide (7424.5 vs. 3209.5 pg/mL, p<0.05). The single patient with liver failure also developed multiorgan failure requiring vasopressors, hemodialysis, and mechanical ventilation.
    • All patients were discharged, though more than 50% had persistent hepatitis up to one month after discharge. The authors conclude that despite positive outcomes, close follow-up is warranted given the limited knowledge of the long-term impact of SARS-CoV-2 on the liver.
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      Cantor A, Miller J, Zachariah P, DaSilva B, Margolis K, Martinez M. Acute hepatitis is a prominent presentation of the multisystem inflammatory syndrome in Children. A single center report. Hepatology. 2020 Aug 18. doi: 10.1002/hep.31526. PMID: 32810894

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