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Recent Experience: Corticosteroids as a First-line Therapy in Children With Multisystem Inflammatory Syndrome and
Vladislav Vukomanovic1,2, Stasa Krasic1, Sergej Prijic1,2
1From the Cardiology Department, Mother and Child Health Institute of Serbia.
Insights
Corticosteroids (CS) significantly improved outcomes in children with multisystem inflammatory syndrome (MIS-C) and cardiac issues compared to intravenous immunoglobulin (IVIG). CS treatment led to faster recovery, reduced inflammation, and shorter intensive care unit stays.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection can cause cardiovascular complications.
- The optimal treatment strategy for MIS-C-related myocarditis and cardiac dysfunction remains unclear.
Purpose of the Study:
- To compare the effectiveness of corticosteroid (CS) versus intravenous immunoglobulin (IVIG) treatment in children with MIS-C and acute left ventricular systolic dysfunction.
- To identify risk factors for treatment failure in this patient population.
Main Methods:
- Retrospective cohort study of 19 pediatric patients with MIS-C and left ventricular systolic dysfunction.
- Patients were treated with either IVIG or CS.
- Outcomes including treatment failure, fever resolution, inflammatory markers, and intensive care unit (ICU) stay were analyzed.
Main Results:
- Treatment failure was significantly higher in the IVIG group (7/10) compared to the CS group (1/9).
- CS treatment was associated with faster resolution of fever, decreased C-reactive protein (CRP), and improved left ventricular ejection fraction (EF).
- Patients treated with CS had shorter ICU stays than those treated with IVIG.
Conclusions:
- Corticosteroids appear to be a more effective initial treatment than IVIG for children with MIS-C and cardiovascular involvement.
- CS therapy is linked to quicker normalization of cardiac function, inflammatory markers, and reduced hospitalization duration.
Background:
Cardiovascular complications with myocarditis in multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 infection have been reported, but the optimal therapeutic strategy remains unknown.
Methods:
A retrospective cohort study included 19 patients with acute left ventricular systolic dysfunction associated with MIS-C, average years of age 13.2 ± 3.8, treated from April 2020 to April 2021.
Results:
Treatment failure (TF) was observed in 8 patients (in the intravenous immunoglobulin [IVIG] group 7/10; in the corticosteroid [CS] group 1/9). The independent risk factor for TF was IVIG treatment (odds ratio [OR] 18.6, 95% confidence interval [CI] 1.6-222.93, P = 0.02). Patients initially treated with CS became afebrile during in-hospital day 1 (1.5, interquartile range [IQR] 1-2), while IVIG-treated patients became afebrile on in-hospital day 4 (IQR 2-4.25), after CS was added. The C-reactive protein (CRP) significantly declined in CS-treated patients on day 2 (P = 0.01), while in the IVIG group, CRP decreased significantly on the fourth day (P = 0.04). Sodium and albumin levels were higher on third in-hospital day in the CS group than in the IVIG group (P = 0.015, P = 0.03). A significant improvement and normalization of ejection fraction (EF) during the first 3 days was observed only in the CS group (P = 0.005). ICU stays were shorter in the CS group (4, IQR 2-5.5) than in the IVIG group (IVIG group 7, IQR 6-8.5) (P = 0.002).
Conclusions:
Among children with MIS-C with cardiovascular involvement, treatment with CS was associated with faster normalization of LV EF, fever, laboratory analysis, and shorter ICU than IVIG-treated patients.
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