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Association Between Treatments and Short-Term Biochemical Improvements and Clinical Outcomes in Post-Severe Acute

Patrick Davies1,2, Jon Lillie3, Andrew Prayle1,4

  • 1Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|March 26, 2021
PubMed

Insights

This study found no short-term benefits for common treatments like IV immunoglobulin, steroids, or biologics in children with pediatric inflammatory multisystem syndrome. Further clinical trials are needed to determine optimal therapies for this condition.

Area of Science:

  • Pediatric critical care medicine
  • Infectious diseases
  • Immunology

Background:

  • Post-severe acute respiratory syndrome coronavirus-2 inflammatory syndrome, also known as multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is a serious condition affecting children.
  • Current treatment guidelines in the UK recommend specific immunomodulatory therapies, but evidence for their short-term efficacy is limited.

Purpose of the Study:

  • To analyze short-term biochemical improvements and clinical outcomes in children treated for MIS-C/PIMS-TS admitted to UK Pediatric Intensive Care Units (PICUs).
  • To collate and review current treatment guidance for MIS-C/PIMS-TS from UK PICUs.

Main Methods:

  • A multicenter observational study involving 21 UK PICUs.
  • Analysis of routinely collected, deidentified data from children (<18 years) admitted between April 1, 2020, and May 10, 2020, who met the UK case definition for PIMS-TS.
  • Use of propensity score and linear mixed effects models to assess the impact of steroids, IV immunoglobulin, and biologic agents on inflammatory markers (C-reactive protein, platelet, lymphocyte counts).

Main Results:

  • Of 78 children studied, a majority received immunomodulatory treatment: IV immunoglobulin (76%), steroids (73%), and biologic agents (24%).
  • No significant difference in the response of clinical markers of inflammation was observed between treated and untreated patients, or among different treatment groups.
  • Patients who did not receive immunomodulators showed a similar decrease in inflammatory markers compared to those who did.

Conclusions:

  • No short-term benefit was identified for any of the administered treatments or combinations for MIS-C/PIMS-TS.
  • Despite a lack of evidence, UK treatment guidelines have converged on recommending stepwise immunomodulatory approaches.
  • Maintaining clinical equipoise is crucial to facilitate enrollment in robust clinical trials to establish optimal treatments for MIS-C/PIMS-TS.
Abstract

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