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Pediatric Nephrology

Erschienen in:

08.07.2023 | Original Article

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

verfasst von: Jake R. Lehman, Matthew Schuchman, Elizabeth Mitchell, Christine A. Capone, Christine B. Sethna

Erschienen in: Pediatric Nephrology | Ausgabe 12/2023

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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.

Graphical abstract

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CDC (2021) HAN archive - 00432. In: Health Alert Network (HAN). https://emergency.cdc.gov/han/2020/han00432.asp. Accessed 3 Jul 2023

Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, Barranco MA, Maxted AM, Rosenberg ES, Easton D, Udo T, Kumar J, Pulver W, Smith L, Hutton B, Blog D, Zucker H, New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team (2020) Multisystem inflammatory syndrome in children in New York state. N Engl J Med 383:347–358. https://doi.org/10.1056/NEJMoa2021756CrossRefPubMed

Basalely A, Gurusinghe S, Schneider J, Shah SS, Siegel LB, Pollack G, Singer P, Castellanos-Reyes LJ, Fishbane S, Jhaveri KD, Mitchell E, Merchant K, Capone C, Gefen AM, Steinberg J, Sethna CB (2021) Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19. Kidney Int 100:138–145. https://doi.org/10.1016/j.kint.2021.02.026CrossRefPubMedPubMedCentral

Valverde I, Singh Y, Sanchez-de-Toledo J, Theocharis P, Chikermane A, Di Filippo S, Kucinska B, Mannarino S, Tamariz-Martel A, Gutierrez-Larraya F, Soda G, Vandekerckhove K, Gonzalez-Barlatay F, McMahon CJ, Marcora S, Napoleone CP, Duong P, Tuo G, Deri A et al (2021) Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation 143:21–32. https://doi.org/10.1161/CIRCULATIONAHA.120.050065CrossRefPubMed

Parr SK, Siew ED (2016) Delayed consequences of acute kidney injury. Adv Chronic Kidney Dis 2:186–194. https://doi.org/10.1053/j.ackd.2016.01.014CrossRef

Friedman KG, Gauvreau K, Hamaoka-Okamoto A, Tang A, Berry E, Tremoulet AH, Mahavadi VS, Baker A, de Ferranti SD, Fulton DR, Burns JC, Newburger JW (2016) Coronary artery aneurysms in Kawasaki disease: risk factors for progressive disease and adverse cardiac events in the US population. J Am Heart Assoc 5:e003289. https://doi.org/10.1161/JAHA.116.003289CrossRefPubMedPubMedCentral

Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, Kazue T, Eto G, Yamakawa R (1996) Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 94:1379–1385. https://doi.org/10.1161/01.cir.94.6.1379CrossRefPubMed

Hsu CY, Hsu RK, Yang J, Ordonez JD, Zheng S, Go AS (2016) Elevated BP after AKI. J Am Soc Nephrol 27:914–923. https://doi.org/10.1681/ASN.2014111114CrossRefPubMed

Flynn JT, Kaelber DC, Baker-Smith CM, Subcommittee on Screening and Management of High Blood Pressure in Children et al (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904. https://doi.org/10.1542/peds.2018-1739CrossRefPubMed

10.

Kidney Disease Improving Global Outcomes (2012) Summary of Recommendation Statements. Kidney Int Suppl 2:8–12. https://doi.org/10.1038/kisup.2012.7

11.

Sluysmans T, Colan SD (2016) Structural measurements and adjustments for growth. In: Echocardiography in Pediatric and Congenital Heart Disease. John Wiley & Sons, Ltd, Oxford, UK, pp 61–72

12.

Colan SD (2012) Normal echocardiographic values for cardiovascular structure. In: Lai WW, Mertens LL, Geva T, Cohen MS. Echocardiography in Pediatric and Congenital Heart Disease: From Fetus to Adult. John Wiley & Sons

13.

Khoury PR, Mitsnefes M, Daniels SR, Kimball TR (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 22:709–714. https://doi.org/10.1016/j.echo.2009.03.003CrossRefPubMed

14.

McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E et al (2017) Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 135:e927–e999. https://doi.org/10.1161/CIR.0000000000000484CrossRefPubMed

15.

Tadic M, Cuspidi C, Mancia G, Dell’Oro R, Grassi G (2020) COVID-19, hypertension and cardiovascular diseases: should we change the therapy? Pharmacol Res 158:104906. https://doi.org/10.1016/j.phrs.2020.104906CrossRefPubMedPubMedCentral

16.

Barekat M, Shahrbaf MA, Rahi K, Vosough M (2022) Hypertension in COVID-19, a risk factor for infection or a late consequence? Cell J 24:424–426. https://doi.org/10.22074/cellj.2022.8487CrossRefPubMedPubMedCentral

17.

Chen G, Li X, Gong Z, Xia H, Wang Y, Wang X, Huang Y, Barajas-Martinez H, Hu D (2021) Hypertension as a sequela in patients of SARS-CoV-2 infection. PLos One 16:e0250815. https://doi.org/10.1371/journal.pone.0250815CrossRefPubMedPubMedCentral

18.

Jackson SL, Zhang Z, Wiltz JL, Loustalot F, Ritchey MD, Goodman AB, Yang Q (2018) Hypertension among youths—United States, 2001–2016. Am J Transplant 18:2356–2360. https://doi.org/10.1111/ajt.15050CrossRef

19.

Song P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K, Rudan I (2019) Global prevalence of hypertension in children: a systematic review and meta-analysis. JAMA Pediatr 173:1154–1163. https://doi.org/10.1001/jamapediatrics.2019.3310CrossRefPubMedPubMedCentral

20.

Papageorghiou AT, Deruelle P, Gunier RB, Rauch S, Garcia-May PK, Mhatre M, Usman MA, Abd-Elsalam S, Etuk S, Simmons LE, Napolitano R, Deantoni S, Liu B, Prefumo F, Savasi V, do Vale MS, Baafi E, Zainab G, Nieto R, et al (2021) Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study. Am J Obstet Gynecol 225:e281–e289. https://doi.org/10.1016/j.ajog.2021.05.014CrossRef

21.

Parker ED, Sinaiko AR, Kharbanda EO, Margolis KL, Daley MF, Trower NK, Sherwood NE, Greenspan LC, Lo JC, Magid DJ, O’Connor PJ (2016) Change in weight status and development of hypertension. Pediatrics 137:e20151662. https://doi.org/10.1542/peds.2015-1662CrossRefPubMedPubMedCentral

22.

Whitworth JA (1992) Adrenocorticotrophin and steroid-induced hypertension in humans. Kidney Int (Suppl 37):S34-S37. https://www.ncbi.nlm.nih.gov/pubmed/1321309

23.

Everett B, Zajacova A (2015) Gender differences in hypertension and hypertension awareness among adults. Biodemography Soc Biol 61:1–17. https://doi.org/10.1080/19485565.2014.929488CrossRefPubMedPubMedCentral

24.

Theocharis R, Wong J, Pushparajah K, Mathur SK, Simpson JM, Pascall E, Cleary A, Stewart K, Adhvaryu K, Savis A, Kabir SR, Uy MP, Heard H, Peacock K, Miller O (2021) Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19. Eur Heart J Cardiovasc Imaging 22:896–903. https://doi.org/10.1093/ehjci/jeaa212CrossRefPubMed

25.

Belhadjer Z, Meot M, Bajolle F, Khraiche D, Legendre A, Abakka S, Auriau J, Grimaud M, Oualha M, Beghetti M, Wacker J, Ovaert C, Hascoet S, Selegny M, Malekzadeh-Milani S, Maltret A, Bosser G, Giroux N, Bonnemains L et al (2020) Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation 142:429–436. https://doi.org/10.1161/CIRCULATIONAHA.120.048360CrossRefPubMed

26.

Kobayashi R, Dionne A, Ferraro A, Harrild D, Newburger J, VanderPluym C, Gauvreau K, Son MB, Lee P, Baker A, de Ferranti S, Friedman KG (2021) Detailed assessment of left ventricular function in multisystem inflammatory syndrome in children, using strain analysis. CJC Open 3:880–887. https://doi.org/10.1016/j.cjco.2021.02.012CrossRefPubMedPubMedCentral

27.

Rao G (2016) Diagnosis, epidemiology, and management of hypertension in children. Pediatrics 138. https://doi.org/10.1542/peds.2015-3616

28.

Yang L, Magnussen CG, Yang L, Bovet P, Xi B (2020) Elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood: a systematic review. Hypertension 75:948–955. https://doi.org/10.1161/HYPERTENSIONAHA.119.14168CrossRefPubMed

Titel: Hypertension after multisystem inflammatory syndrome in children (MIS-C)
verfasst von: Jake R. Lehman
Matthew Schuchman
Elizabeth Mitchell
Christine A. Capone
Christine B. Sethna
Publikationsdatum: 08.07.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 12/2023
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-023-06061-2

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

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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