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Early is superior to late plasma exchange for severe multisystem inflammatory syndrome in children
Banu Katlan1, Selman Kesici2, Dilek Karacanoğlu1
1Department of Pediatric Critical Care Medicine, Hacettepe University, Ankara, Turkey.
Insights
Early plasma exchange (PE) significantly improves outcomes for children with severe multisystem inflammatory syndrome (MIS-C). This life-saving treatment reduces mortality, shortens hospital stays, and decreases the need for mechanical ventilation.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Infectious diseases
Background:
- Multisystem inflammatory syndrome in children (MIS-C) can cause severe inflammation and multi-organ failure.
- Early intervention is crucial for managing life-threatening MIS-C cases.
Purpose of the Study:
- To evaluate the impact of plasma exchange (PE) in treating severe MIS-C.
- To emphasize the benefits of early PE administration on patient outcomes.
Main Methods:
- Retrospective observational study of 18 severe MIS-C patients in the pediatric intensive care unit.
- Patients received the PISA protocol: plasma exchange (PE), intravenous immunoglobulin, steroids, and anakinra.
- Comparison between early PE (E-PE) and late PE (L-PE) groups based on time to PE administration.
Main Results:
- No mortality in the E-PE group versus 20% mortality in the L-PE group.
- E-PE group showed faster acute phase reactant response and reduced need for immunomodulatory treatments.
- E-PE group had lower rates and shorter durations of mechanical ventilation and inotropic support, with shorter hospital and PICU stays.
Conclusions:
- Timely plasma exchange is a beneficial rescue therapy for MIS-C with severe cardiovascular collapse.
- Early administration of PE in MIS-C patients can significantly improve clinical outcomes and reduce mortality.
Background:
Multisystem inflammatory syndrome in children (MIS-C) can be life threatening in severe cases because of uncontrolled inflammation and multi-organ failure. In this study, we report the effect of plasma exchange in the treatment of MIS-C and to emphasize the effect of its early application on outcome.
Method:
In this retrospective observational study, the medical records of children with severe MIS-C admitted to pediatric intensive care unit (PICU) between April 2020 and January 2021 were reviewed. Severe MIS-C patients were treated according to protocol consisting of plasma exchange (PE), intravenous immune globulin, steroids, and anakinra which we called the "PISA" protocol referring to the initials. The patients were divided into two groups as early plasma exchange (E-PE) and late plasma exchange (L-PE) according to the elapse time between hospital admission and the administration of PE. Groups were compared in terms of outcome variables. Primary study outcome was 28-day mortality. Secondary outcome variables were acute phase response time, length of immunomodulatory treatment, frequency of patients requiring mechanical ventilation (MV) and inotropic support, length of inotropic support and MV, length of hospital and PICU stays.
Results:
Eighteen pediatric patients with MIS-C were included in the study. Seventeen (95%) of the patients presented with decompensated shock and required inotropic support. One of the 17 patients needed extracorporeal membrane oxygenation support (ECMO) PISA protocol was used in all patients. There was no mortality in the E-PE group while the mortality rate was 20% in the L-PE group. Acute phase reactant response was faster in the E-PE group and immunomodulatory treatments could be reduced earlier; the frequency of patients requiring inotropic and mechanical ventilation (MV) support was lower in the E-PE group; the duration of inotropic support, duration of MV, and length of stay in hospital and PICU were significantly shorter in the E-PE group.
Conclusion:
We suggest that in selected cases, timely administration of PE is a beneficial rescue therapy for MIS-C related hyperinflammation presenting with severe cardiovascular collapse.
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