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Hypertension after multisystem inflammatory syndrome in children (MIS-C)

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Abstract

Background

Multisystem inflammatory syndrome in children (MIS-C) is associated with SARS-CoV-2. Long-term consequences of MIS-C remain unknown. The objective was to describe the prevalence and clinical predictors of hypertension (HTN) and elevated blood pressure (BP) following MIS-C.

Methods

A retrospective study of children ≤ 18 years admitted to a tertiary center with MIS-C was performed. HTN and elevated BP were classified as per the 2017 American Academy of Pediatrics Clinical Practice Guidelines and indexed to the 95th percentile. Data included demographics, inpatient clinical measures, and echocardiograms over 1-year follow-up. Data were analyzed using Kruskal–Wallis, chi-square, and logistic regression.

Results

Among 63 children hospitalized with MIS-C (mean age 9.7 ± 4.2 years, 58.7% male, body mass index (BMI) z-score 0.59 ± 1.9), 14% had HTN, and 4% had elevated BP > 30 days post-hospitalization. Multivariate linear regression analysis showed that BMI z-score was significantly associated with higher mean systolic (β = 2.664, CI = 1.307–3.980, p < 0.001) and diastolic (β = 2.547, CI = 0.605–4.489, p = 0.012) BP index > 30 days post-hospitalization. Acute kidney injury (AKI) (23.8%) (OR = 2.977, CI = 1.778–4.987, p < 0.001), peak inpatient serum creatinine (OR = 2.524, CI = 1.344–4.740, p = 0.004), and maximum CRP (OR = 1.009, CI = 1.002–1.016, p = 0.014) were all associated with increased odds of post-hospitalization HTN. Left ventricular hypertrophy was present in 46% while hospitalized, compared to 10% at last follow-up. All had return of normal systolic function.

Conclusions

Post-hospitalization HTN and elevated BP may be associated with MIS-C. Children with greater BMI or AKI may be at greater risk for developing HTN after MIS-C. MIS-C follow-up requires careful BP monitoring and antihypertensive medication consideration.

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Funding

Dr. Sethna is supported by NIH/NIDDK R01DK131091.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Jake R. Lehman

  2. The Feinstein Institutes for Medical Research, Manhasset, NY, USA

    Matthew Schuchman & Christine B. Sethna

  3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Elizabeth Mitchell, Christine A. Capone & Christine B. Sethna

  4. Division of Pediatric Cardiology, Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA

    Elizabeth Mitchell & Christine A. Capone

  5. Division of Pediatric Nephrology, Cohen Children’s Medical Center of New York, 269-01 76th Avenue, NY, 11040, New Hyde Park, USA

    Christine B. Sethna

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Contributions

All authors conceptualized and designed the study and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Conceptualization: J.L. and C.S.; methodology: J.L. and C.S.; formal analysis: J.L., C.S., and M.S.; data curation: J.L., M.S., C.S., E.M., and C.C.; writing—original draft preparation: J.L.; writing—review and editing: J.L., M.S., C.S., E.M., and C.C; supervision: C.S.

Corresponding author

Correspondence to Christine B. Sethna.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Institutional Review Board of Northwell Health. Consent from a guardian/parent and assent from children ≥ 7 years were obtained for the prospective piece of this study.

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N/A.

Competing interests

Dr. Sethna was on an advisory board for Travere Therapeutics. All other authors have no conflicting interests to disclose.

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Lehman, J.R., Schuchman, M., Mitchell, E. et al. Hypertension after multisystem inflammatory syndrome in children (MIS-C). Pediatr Nephrol 38, 4083–4091 (2023). https://doi.org/10.1007/s00467-023-06061-2

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  • DOI: https://doi.org/10.1007/s00467-023-06061-2

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