Abstract 11816: Association of Increased Adiposity and Presentation and Outcomes for Kawasaki Disease Versus Multisystem Inflammatory Syndrome in Children Associated with Covid-19

Introduction: Obesity is a pro-inflammatory state and may influence presentation and outcomes of both Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. Methods: From January 2020 to January 2022, n=2566 contemporaneous KD, MIS-C and acute COVID-19 pediatric patients from 39 sites in 8 countries were enrolled into the International KD Registry. The study population was confined to 1077 MIS-C patients meeting CDC criteria with confirmed or probable COVID-19 infection, and 657 KD patients meeting AHA guideline criteria without COVID-19 infection who had body mass index (BMI) recorded at presentation. BMI was converted to Z scores using WHO formulas for age and sex, and associated factors were sought using general linear regression modeling. Results: Mean zBMI was higher for MIS-C (+0.58) vs KD patients (-0.06; p<0.001), and MIS-C patients were more likely to be overweight (BMI 85 th -<95 th %ile; 18% vs 11%), obese (95 th -<99 th %ile; 14% vs 6%) or morbidly obese ( > 99 th %ile; 8% vs 2%; p<0.001). MIS-C patients were significantly more likely to present with shock, and had higher peak troponin I and NTproBNP, with no association or interaction with adiposity. Higher adiposity was significantly associated with higher peak white cell count for MIS-C but not KD. Higher peak CRP for MIS-C and higher peak ESR for KD were not associated with adiposity. Higher peak creatinine was associated higher adiposity, more so for MIS-C. Both higher adiposity and MIS-C were significantly associated with lower LV ejection fraction, although there was no significant interaction (Figure A). Higher maximum coronary artery Z score was associated with KD but not with adiposity, with no significant interaction (Figure B). Conclusions: MIS-C patients have higher levels of adiposity than KD patients. Higher adiposity is associated with greater renal dysfunction in the setting of MIS-C, and greater cardiac dysfunction in both MIS-C and KD.