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Initial Immunomodulation and Outcome of Children with Multisystem Inflammatory Syndrome Related to COVID-19: A

Narendra Kumar Bagri1, M Khan2, R M Pandey2

  • 1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.

Indian Journal of Pediatrics
|June 14, 2022
PubMed

Insights

Treatment for pediatric multisystem inflammatory syndrome (MIS-C) showed no significant differences in outcomes between IVIG alone, steroids alone, or combined therapy. Further randomized controlled trials are needed for definitive MIS-C treatment recommendations.

Area of Science:

  • Pediatric critical care medicine
  • Immunology
  • Infectious diseases

Background:

  • Multisystem inflammatory syndrome in children (MIS-C) is a serious condition requiring prompt treatment.
  • Understanding the efficacy of different immunomodulatory therapies is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare treatment outcomes in children diagnosed with MIS-C based on varying immunomodulatory strategies.
  • To evaluate the effectiveness of intravenous immunoglobulin (IVIG) alone, corticosteroids alone, and combination therapy.

Main Methods:

  • A multicentric, retrospective cohort study analyzed data from 368 children meeting the WHO MIS-C case definition.
  • Outcomes were assessed using logistic regression and propensity score matching, focusing on the need for vasoactive support, mechanical ventilation, or in-hospital death.
  • Treatment arms included IVIG alone, steroids alone, IVIG plus steroids, and no immunomodulation.

Main Results:

  • The primary composite outcome occurred in 42.39% of patients.
  • No significant association was found between the treatment group and the primary outcome.
  • Children presenting with shock at diagnosis had significantly higher odds of the primary outcome (OR: 11.4).
  • Propensity score matching showed comparable primary outcomes between steroid and IVIG plus steroid groups.

Conclusions:

  • Current immunomodulatory treatments for MIS-C did not demonstrate significant differences in the primary outcome in this cohort.
  • Shock at diagnosis emerged as a key predictor of adverse outcomes.
  • Larger, adequately powered randomized controlled trials are necessary to establish definitive treatment guidelines for MIS-C.
Abstract

Keywords:
COVID-19IVIGMIS-COutcomePropensity scoringResource-poor setting, SteroidsTreatment modality

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