{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:21:14Z","timestamp":1787923274019,"version":"build-2784847793"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Multisystem inflammatory syndrome in children (MIS-C) is a severe and unrestrained inflammatory response with multiorgan involvement, which occurs within a few weeks following the resolution of acute SARS-CoV-2 infection. The complement system is a vital part of the innate immune system and plays a role in COVID-19 pathogenesis.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine and compare the levels of complement components and regulators along with complement activation products in the different clinical spectrum of children with SARS-CoV-2 and a control group.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study analyzed children with MIS-C admitted to a single hospital in India from June through September 2020. Eligible participants were children who were hospitalized of either sex, aged 1 to 18 years. Data were analyzed August 2022.<\/jats:p>\n <\/jats:sec>\n \n Measures<\/jats:title>\n \n Levels of complement components and regulators along with complement activation products in all the groups of children. Mann-Whitney\n U<\/jats:italic>\n test and Kruskal-Wallis analysis were used to compare the complement component levels, and Spearman rank correlation analysis was used to describe the association between complement components and laboratory and biochemical parameters.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total 145 children were included (median age, 5 years [range, 1 month-17 years); 84 [58%] male): 44 children with MIS-C, 33 with acute COVID-19 (reverse transcriptase\u2013polymerase chain reaction [RT-PCR] positive), 47 with convalescent COVID-19 (immunoglobulin G\u2013positive non-MIS-C) and 21 children for a control group (both serology and RT-PCR negative). Children with MIS-C and COVID-19 had higher levels of C1q (geometric mean [SD]: MIS-C, 61.5 [18.5] ng\/mL; acute COVID-19, 56.9 [18.6] ng\/mL; controls, 24.1 [3.3] ng\/mL), C2 (MIS-C, 605.8 [219.7] ng\/mL; acute COVID-19, 606.4 [167.7] ng\/mL; controls, 255.9 [73.3] ng\/mL), C3 (MIS-C, 318.2 [70.7] ng\/mL; acute COVID-19, 237.7 [61.8] ng\/mL; controls, 123.4 [15.7] ng\/mL), C4b (MIS-C, 712.4 ng\/mL; acute COVID-19, 640.7 ng\/mL; controls, 351.5 ng\/mL), C5 (MIS-C, 1487 ng\/mL; acute COVID-19, 1364 ng\/mL; controls, 561.9 ng\/mL), C5a, (MIS-C, 2614.0 [336.2] ng\/mL; acute COVID-19, 1826.0 [541.0] ng\/mL; controls, 462.5 [132.4] ng\/mL), C3b\/iC3b (MIS-C, 3971.0 [635.1] ng\/mL; acute COVID-19, 3702.0 [653.9] ng\/mL; controls, 2039.0 [344.5] ng\/mL), and factor B (MIS-C, 47.6 [7.8] ng\/mL; acute COVID-19, 44.6 [6.3] ng\/mL; controls, 27.5 [5.0] ng\/mL), factor D (MIS-C, 44.0 [17.2] ng\/mL; acute COVID-19, 33.8 [18.4] ng\/mL; controls, 21.3 [6.1] ng\/mL), and factor H (MIS-C, 53.1 [4.0] ng\/mL; acute COVID-19, 50.8 [5.7] ng\/mL; controls, 43.6 [3.8] ng\/mL) in comparison with convalescent and control children. In addition, children with MIS-C had significantly elevated levels of C3 (318.2 [70.7] ng\/mL vs 237.7 [61.8] ng\/mL), C5a (2614 [336.2] ng\/mL vs 1826 [541.0] ng\/mL), and mannose-binding lectin (79.4 [12.4] ng\/mL vs 69.6 [14.7] ng\/mL) in comparison to children with acute COVID-19. Levels of some of these analytes at admission (ie, pretreatment) were more elevated in children with MIS-C who needed pediatric intensive care unit (PICU) support as compared with those who did not require PICU support, and in children with COVID-19 who developed moderate to severe disease compared with those who developed mild disease. Overall, MIS-C and acute COVID-19 were associated with the hyperactivation of complement components and complement regulators.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study, the complement system was associated with the pathogenesis of MIS-C and COVID-19 in children; complement inhibition could be further explored as a potential treatment option.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.1713","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T11:03:18Z","timestamp":1679655798000},"page":"e231713","source":"Crossref","is-referenced-by-count":16,"title":["Levels of Complement Components in Children With Acute COVID-19 or Multisystem Inflammatory Syndrome"],"prefix":"10.1001","volume":"6","author":[{"given":"Anuradha","family":"Rajamanickam","sequence":"first","affiliation":[{"name":"National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavan Kumar","family":"Nathella","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Venkataraman","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bindu","family":"Dasan","sequence":"additional","affiliation":[{"name":"National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulochana","family":"Putlibai","sequence":"additional","affiliation":[{"name":"Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaik Fayaz","family":"Ahamed","sequence":"additional","affiliation":[{"name":"National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandhini","family":"Selvaraj","sequence":"additional","affiliation":[{"name":"National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalaimaran","family":"Sadasivam","sequence":"additional","affiliation":[{"name":"Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balasubramanian","family":"Sundaram","sequence":"additional","affiliation":[{"name":"Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas B.","family":"Nutman","sequence":"additional","affiliation":[{"name":"Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subash","family":"Babu","sequence":"additional","affiliation":[{"name":"National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India"},{"name":"Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"issue":"7","key":"zoi230082r3","doi-asserted-by":"publisher","first-page":"2019","DOI":"10.1007\/s00431-021-03993-5","article-title":"Multisystem inflammatory syndrome in children related to COVID-19: a systematic review.","volume":"180","author":"Hoste","year":"2021","journal-title":"Eur J Pediatr"},{"issue":"3","key":"zoi230082r4","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1007\/s00296-021-05030-y","article-title":"Outcomes of multisystem inflammatory syndrome in children temporally related to COVID-19: a longitudinal study.","volume":"42","author":"Bagri","year":"2022","journal-title":"Rheumatol Int"},{"issue":"1","key":"zoi230082r5","doi-asserted-by":"publisher","first-page":"121","DOI":"10.21037\/tp","article-title":"Multisystem inflammatory syndrome in children during the coronavirus disease 2019 (COVID-19) pandemic: a systematic review of published case studies.","volume":"10","author":"Tang","year":"2021","journal-title":"Transl Pediatr"},{"issue":"24","key":"zoi230082r6","doi-asserted-by":"publisher","first-page":"2452","DOI":"10.1001\/jama.2022.8025","article-title":"Severity and incidence of multisystem inflammatory syndrome in children during 3 SARS-CoV-2 pandemic waves in Israel.","volume":"327","author":"Levy","year":"2022","journal-title":"JAMA"},{"issue":"15","key":"zoi230082r7","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.140711","article-title":"The complement system in COVID-19: friend and foe?","volume":"5","author":"Java","year":"2020","journal-title":"JCI Insight"},{"issue":"59","key":"zoi230082r8","doi-asserted-by":"publisher","DOI":"10.1126\/sciimmunol.abh2259","article-title":"Increased complement activation is a distinctive feature of severe SARS-CoV-2 infection.","volume":"6","author":"Ma","year":"2021","journal-title":"Sci Immunol"},{"issue":"6","key":"zoi230082r9","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1038\/s41577-020-0320-7","article-title":"Complement as a target in COVID-19?","volume":"20","author":"Risitano","year":"2020","journal-title":"Nat Rev Immunol"},{"issue":"40","key":"zoi230082r10","doi-asserted-by":"publisher","first-page":"25018","DOI":"10.1073\/pnas.2010540117","article-title":"Systemic complement activation is associated with respiratory failure in COVID-19 hospitalized patients.","volume":"117","author":"Holter","year":"2020","journal-title":"Proc Natl Acad Sci U S A"},{"key":"zoi230082r11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.trsl.2020.04.007","article-title":"Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases.","volume":"220","author":"Magro","year":"2020","journal-title":"Transl Res"},{"issue":"9","key":"zoi230082r12","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1164\/rccm.202007-2778LE","article-title":"Complement inhibition with the C5 blocker LFG316 in severe COVID-19.","volume":"202","author":"Zelek","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"11","key":"zoi230082r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.isci.2021.103215","article-title":"The immune landscape of SARS-CoV-2-associated multisystem inflammatory syndrome in children (MIS-C) from acute disease to recovery.","volume":"24","author":"Syrimi","year":"2021","journal-title":"iScience"},{"issue":"11","key":"zoi230082r14","doi-asserted-by":"publisher","first-page":"6151","DOI":"10.1172\/JCI141374","article-title":"Complement and tissue factor-enriched neutrophil extracellular traps are key drivers in COVID-19 immunothrombosis.","volume":"130","author":"Skendros","year":"2020","journal-title":"J Clin Invest"},{"issue":"20","key":"zoi230082r15","doi-asserted-by":"publisher","DOI":"10.1172\/JCI151520","article-title":"The autoimmune signature of hyperinflammatory multisystem inflammatory syndrome in children.","volume":"131","author":"Porritt","year":"2021","journal-title":"J Clin Invest"},{"issue":"5","key":"zoi230082r16","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1016\/j.jaci.2017.11.046","article-title":"The complement system in the airway epithelium: an overlooked host defense mechanism and therapeutic target?","volume":"141","author":"Kulkarni","year":"2018","journal-title":"J Allergy Clin Immunol"},{"issue":"1","key":"zoi230082r18","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.jaci.2020.05.006","article-title":"Complement activation in patients with COVID-19: a novel therapeutic target.","volume":"146","author":"Cugno","year":"2020","journal-title":"J Allergy Clin Immunol"},{"issue":"7836","key":"zoi230082r19","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1038\/s41586-020-2600-6","article-title":"Association of COVID-19 inflammation with activation of the C5a-C5aR1 axis.","volume":"588","author":"Carvelli","year":"2020","journal-title":"Nature"},{"issue":"1","key":"zoi230082r21","doi-asserted-by":"publisher","first-page":"19759","DOI":"10.1038\/s41598-022-23806-5","article-title":"Evidence, detailed characterization and clinical context of complement activation in acute multisystem inflammatory syndrome in children.","volume":"12","author":"Sinkovits","year":"2022","journal-title":"Sci Rep"},{"issue":"10","key":"zoi230082r22","doi-asserted-by":"publisher","first-page":"2517","DOI":"10.3324\/haematol.2022.280603","article-title":"The successful use of eculizumab for treatment of thrombotic microangiopathy in pediatric acute SARSCoV2 infection and multisystem inflammatory syndrome in children.","volume":"107","author":"Aurora","year":"2022","journal-title":"Haematologica"},{"issue":"23","key":"zoi230082r23","doi-asserted-by":"publisher","first-page":"6051","DOI":"10.1182\/bloodadvances.2020003471","article-title":"Evidence of thrombotic microangiopathy in children with SARS-CoV-2 across the spectrum of clinical presentations.","volume":"4","author":"Diorio","year":"2020","journal-title":"Blood Adv"},{"issue":"11","key":"zoi230082r24","doi-asserted-by":"publisher","first-page":"5967","DOI":"10.1172\/JCI140970","article-title":"Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS-CoV-2.","volume":"130","author":"Diorio","year":"2020","journal-title":"J Clin Invest"},{"issue":"1","key":"zoi230082r25","doi-asserted-by":"publisher","first-page":"2391","DOI":"10.1038\/s41467-022-29951-9","article-title":"Pathophysiological pathway differences in children who present with COVID-19 ARDS compared to COVID-19 induced MIS-C.","volume":"13","author":"McCafferty","year":"2022","journal-title":"Nat Commun"},{"key":"zoi230082r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2021.103317","article-title":"Plasma biomarker profiling of PIMS-TS, COVID-19 and SARS-CoV2 seropositive children\u2014a cross-sectional observational study from southern India.","volume":"66","author":"Venkataraman","year":"2021","journal-title":"EBioMedicine"},{"issue":"7","key":"zoi230082r27","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab279","article-title":"Systemic inflammation and microbial translocation are characteristic features of SARS-CoV-2-related multisystem inflammatory syndrome in children.","volume":"8","author":"Kumar","year":"2021","journal-title":"Open Forum Infect Dis"},{"issue":"1","key":"zoi230082r28","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/fmab015","article-title":"Correlation of SARS-CoV-2 serology and clinical phenotype amongst hospitalised children in a tertiary children\u2019s hospital in India.","volume":"67","author":"Venkataraman","year":"2021","journal-title":"J Trop Pediatr"},{"issue":"11","key":"zoi230082r29","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1007\/s13312-020-2025-1","article-title":"Epidemiological and clinical profile of pediatric inflammatory multisystem syndrome\u2014temporally associated with SARS-CoV-2 (PIMS-TS) in Indian children.","volume":"57","author":"Dhanalakshmi","year":"2020","journal-title":"Indian Pediatr"},{"issue":"2","key":"zoi230082r31","doi-asserted-by":"publisher","first-page":"312","DOI":"10.3390\/v13020312","article-title":"Targeting the complement serine protease MASP-2 as a therapeutic strategy for coronavirus infections.","volume":"13","author":"Flude","year":"2021","journal-title":"Viruses"},{"issue":"5","key":"zoi230082r32","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.01753-18","article-title":"Complement activation contributes to severe acute respiratory syndrome coronavirus pathogenesis.","volume":"9","author":"Gralinski","year":"2018","journal-title":"mBio"},{"issue":"1","key":"zoi230082r33","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1038\/s41426-018-0063-8","article-title":"Blockade of the C5a-C5aR axis alleviates lung damage in hDPP4-transgenic mice infected with MERS-CoV.","volume":"7","author":"Jiang","year":"2018","journal-title":"Emerg Microbes Infect"},{"issue":"18","key":"zoi230082r34","doi-asserted-by":"publisher","first-page":"2080","DOI":"10.1182\/blood.2020008248","article-title":"Direct activation of the alternative complement pathway by SARS-CoV-2 spike proteins is blocked by factor D inhibition.","volume":"136","author":"Yu","year":"2020","journal-title":"Blood"},{"issue":"6501","key":"zoi230082r35","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1126\/science.abb9983","article-title":"Site-specific glycan analysis of the SARS-CoV-2 spike.","volume":"369","author":"Watanabe","year":"2020","journal-title":"Science"},{"issue":"5","key":"zoi230082r36","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1182\/bloodadvances.2020003259","article-title":"The SARS-CoV-2 receptor-binding domain preferentially recognizes blood group A.","volume":"5","author":"Wu","year":"2021","journal-title":"Blood Adv"},{"issue":"5","key":"zoi230082r37","doi-asserted-by":"publisher","DOI":"10.1038\/emi.2015.28","article-title":"The role of C5a in acute lung injury induced by highly pathogenic viral infections.","volume":"4","author":"Wang","year":"2015","journal-title":"Emerg Microbes Infect"},{"issue":"2","key":"zoi230082r38","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/j.virol.2010.12.045","article-title":"Complement and viral pathogenesis.","volume":"411","author":"Stoermer","year":"2011","journal-title":"Virology"},{"issue":"1","key":"zoi230082r39","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.cell.2020.05.032","article-title":"Proteomic and metabolomic characterization of COVID-19 patient sera.","volume":"182","author":"Shen","year":"2020","journal-title":"Cell"},{"issue":"1","key":"zoi230082r40","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.cels.2020.05.012","article-title":"Ultra-high-throughput clinical proteomics reveals classifiers of COVID-19 infection.","volume":"11","author":"Messner","year":"2020","journal-title":"Cell Syst"},{"issue":"2-3","key":"zoi230082r41","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s00430-021-00704-7","article-title":"An update: the emerging evidence of complement involvement in COVID-19.","volume":"210","author":"Li","year":"2021","journal-title":"Med Microbiol Immunol"},{"issue":"12","key":"zoi230082r42","doi-asserted-by":"publisher","first-page":"2847","DOI":"10.3324\/haematol.2020.260117","article-title":"Complement C5 inhibition in patients with COVID-19\u2014a promising target?","volume":"105","author":"Peffault de Latour","year":"2020","journal-title":"Haematologica"},{"issue":"2","key":"zoi230082r43","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.kint.2020.05.013","article-title":"The case of complement activation in COVID-19 multiorgan impact.","volume":"98","author":"Noris","year":"2020","journal-title":"Kidney Int"},{"issue":"7","key":"zoi230082r44","doi-asserted-by":"publisher","first-page":"2811","DOI":"10.3390\/cimb44070193","article-title":"Targeted genotyping of MIS-C patients reveals a potential alternative pathway mediated complement dysregulation during COVID-19 infection.","volume":"44","author":"Gavriilaki","year":"2022","journal-title":"Curr Issues Mol Biol"},{"issue":"3","key":"zoi230082r45","doi-asserted-by":"publisher","first-page":"J276","DOI":"10.1016\/j.jaut.2009.11.014","article-title":"The complement system in systemic autoimmune disease.","volume":"34","author":"Chen","year":"2010","journal-title":"J Autoimmun"},{"issue":"3","key":"zoi230082r46","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1002\/eji.v51.3","article-title":"Deregulated cellular circuits driving immunoglobulins and complement consumption associate with the severity of COVID-19 patients.","volume":"51","author":"Marcos-Jim\u00e9nez","year":"2021","journal-title":"Eur J Immunol"},{"issue":"8","key":"zoi230082r47","doi-asserted-by":"publisher","DOI":"10.15252\/emmm.202012642","article-title":"Rationale for targeting complement in COVID-19.","volume":"12","author":"Polycarpou","year":"2020","journal-title":"EMBO Mol Med"},{"issue":"10","key":"zoi230082r48","doi-asserted-by":"publisher","first-page":"1697","DOI":"10.1086\/429631","article-title":"Mannose-binding lectin in severe acute respiratory syndrome coronavirus infection.","volume":"191","author":"Ip","year":"2005","journal-title":"J Infect Dis"},{"key":"zoi230082r50","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.714511","article-title":"Lectin pathway mediates complement activation by SARS-CoV-2 proteins.","volume":"12","author":"Ali","year":"2021","journal-title":"Front Immunol"},{"issue":"4","key":"zoi230082r51","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.it.2007.02.006","article-title":"Complement and coagulation: strangers or partners in crime?","volume":"28","author":"Markiewski","year":"2007","journal-title":"Trends Immunol"},{"issue":"1","key":"zoi230082r52","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1189\/jlb.3VMR0316-132R","article-title":"Dual inhibition of complement and Toll-like receptors as a novel approach to treat inflammatory diseases-C3 or C5 emerge together with CD14 as promising targets.","volume":"101","author":"Barratt-Due","year":"2017","journal-title":"J Leukoc Biol"},{"issue":"2","key":"zoi230082r53","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1038\/s41577-021-00665-1","article-title":"The state of complement in COVID-19.","volume":"22","author":"Afzali","year":"2022","journal-title":"Nat Rev Immunol"},{"key":"zoi230082r54","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.663187","article-title":"Complement overactivation and consumption predicts in-hospital mortality in SARS-CoV-2 infection.","volume":"12","author":"Sinkovits","year":"2021","journal-title":"Front Immunol"},{"key":"zoi230082r55","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.668725","article-title":"Complement anaphylatoxins and inflammatory cytokines as prognostic markers for COVID-19 severity and in-hospital mortality.","volume":"12","author":"Alosaimi","year":"2021","journal-title":"Front Immunol"},{"key":"zoi230082r1","unstructured":"US Center for Disease Control and Prevention. Information for health care providers about multisystem inflammatory syndrome in children. Accessed January 19, 2023. https:\/\/www.cdc.gov\/mis\/mis-c\/hcp\/index.html"},{"key":"zoi230082r2","unstructured":"Royal College of Paediatrics and Child Health. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Updated September 2020. Accessed January 19, 2023. https:\/\/www.rcpch.ac.uk\/resources\/paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims-guidance"},{"key":"zoi230082r17","doi-asserted-by":"crossref","unstructured":"Gao? T, Zhu? L, Liu? H, . Highly pathogenic coronavirus N protein aggravates inflammation by MASP-2-mediated lectin complement overactivation.? Sig Transduct Target Ther. 2022;7:318. doi:10.1101\/2020.03.29.20041962","DOI":"10.1038\/s41392-022-01133-5"},{"key":"zoi230082r20","doi-asserted-by":"crossref","unstructured":"Paolo Macor? PD, Mangogna? A, Bussani? R, D\u2019Errico? S, . Multi-organ complement deposition in COVID-19 patients.? medRxiv. 2021;2021.01.07.21249116.","DOI":"10.1101\/2021.01.07.21249116"},{"key":"zoi230082r30","unstructured":"Government of India Ministry of Health and Family Welfare. Clinical Management Protocol for COVID-19 (In Adults). Version 6. May 24, 2021. Accessed January 19, 2023. https:\/\/www.mohfw.gov.in\/pdf\/UpdatedDetailedClinicalManagementProtocolforCOVID19adultsdated24052021.pdf"},{"key":"zoi230082r49","doi-asserted-by":"crossref","unstructured":"Catherine? A, Gao? JIB, Walter? JM, Coleman? JM, ; NU COVID Investigators. Bronchoscopy on intubated COVID-19 patients is associated with low infectious risk to operators.? medRxiv. 2020;2020083020177543. doi:10.1101\/2020.08.30.20177543","DOI":"10.1101\/2020.08.30.20177543"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2802757\/rajamanickam_2023_oi_230082_1678906624.10077.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T11:03:24Z","timestamp":1679655804000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2802757"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,24]]},"references-count":55,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.1713","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,24]]}}}