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Abstract: PO0069

Hypertension After Multisystem Inflammatory Syndrome in Children (MIS-C)

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Lehman, Jake R., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Shah, Sareen, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Capone, Christine A., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Sethna, Christine B., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Background

MIS-C is an inflammatory condition in children associated with previous SARS-CoV-2 infection that has significant morbidity. Yet, long-term consequences of MIS-C remain unknown. The objective was to determine the prevalence of hypertension (HTN) and pre-HTN during the inpatient stay and post-hospitalization period in children diagnosed with MIS-C.

Methods

A retrospective study of children <18 years of age admitted to a tertiary center with MIS-C between 3/1/2020-2/28/2021 was performed. Children with a minimum of three documented outpatient blood pressures (BPs) were included. All available BPs were averaged and indexed (SBPi/DBPi) to the 95%ile for age, sex and height for the inpatient stay and post-hospitalization period. HTN was defined as mean SBPi or DBPi >1 during the inpatient stay and post-hospitalization period, or taking blood pressure medications for the diagnosis of HTN. Pre-HTN was defined as mean systolic or diastolic BP >90%ile for age, sex and height. Data were analyzed using paired tests and logistic regression.

Results

Among 66 children with MIS-C (mean age 9.4±4.6 years, 59.1% male, 21.2% Black, BMI z-score 0.48±2), 1.5% were hypertensive while hospitalized compared to 18.2% with post-hospitalization HTN (p<0.001). 4.5% were prehypertensive while hospitalized compared to 21.2% of MIS-C children post-hospitalization (p=0.003). Mean SBPi (0.91±0.13 vs. 0.86±0.06, p=0.03) and DBPi (0.87±0.13 vs. 0.77±0.09, p<0.0001) were significantly greater post-hospitalization compared to during hospitalization. In a multivariate model, Black race (OR 10.9 CI 1.6-75.2, p=0.02) and greater BMI z-score (OR 2.9 CI 1.2-7, p=0.02) were significantly associated with post-hospitalization HTN. Acute kidney injury (21.2%), inpatient steroids (86.4%), outpatient steroids (3%), vasoactive support (36.4%) and other clinical/demographic variables were not associated with post-hospitalization HTN (all p>0.05). After hospitalization, no MIS-C patients were started on antihypertensives for the management of HTN. No left ventricular hypertrophy was noted on echocardiography at six months post-hospitalization in those with HTN.

Conclusion

MIS-C appears to be associated with the development of post-hospitalization pediatric HTN and pre-HTN. Follow-up of children who have recovered from MIS-C requires careful BP monitoring and consideration of antihypertensive medication.