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The Association Between Early Initiation of Systemic Corticosteroids and the Hospital Length of Stay in Patients With
Torrie Reynolds-Herbst1, David Lowe1, Juan M Lozano2
1From the Department of Emergency Medicine, Nicklaus Children's Hospital.
Insights
Early steroid initiation in children with multisystem inflammatory syndrome (MIS-C) significantly reduces hospital length of stay. This finding supports timely corticosteroid treatment for MIS-C patients to improve outcomes.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Infectious diseases
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition requiring hospitalization.
- Current MIS-C treatment involves intravenous immunoglobulin, corticosteroids, and immunomodulators, but timing of steroid initiation is not standardized.
Purpose of the Study:
- To investigate the association between early corticosteroid initiation and hospital length of stay (LOS) in pediatric patients with MIS-C.
Main Methods:
- Retrospective cohort study of 56 MIS-C patients under 21 years hospitalized between March 2020 and September 2021.
- Patients receiving steroids were analyzed, excluding those with sepsis or recent immunoglobulin/steroid use.
- Multivariable linear regression controlled for confounders to assess early steroid impact on LOS.
Main Results:
- Early steroid group (within 24 hours) had a mean administration time of 9.8 hours vs. 44.6 hours for the late group.
- Significant baseline differences existed between early and late steroid groups (C-reactive peptide, cardiac function).
- Early steroid initiation was associated with a statistically significant decrease in hospital LOS by 58.3 hours (P=0.007).
Conclusions:
- Initiating systemic corticosteroids within 24 hours of admission for MIS-C is linked to a shorter hospital stay.
- This suggests a potential benefit of early steroid therapy in managing MIS-C.
Objective:
Patients with multisystem inflammatory syndrome in children (MIS-C) often require hospital admission. Treatment of MIS-C has included intravenous immunoglobulin, systemic corticosteroids, and/or immunomodulators. There is no standardized approach to when steroids should be initiated during treatment. The study objective was to determine whether early initiation of steroids in patients with MIS-C is associated with the duration of hospital length of stay (LOS).
Methods:
This is a single-center retrospective cohort study of patients younger than 21 years who were hospitalized with MIS-C between March 2020 and September 2021 and received steroids. Cases were obtained from an institutional MIS-C log. Patients with culture proven sepsis and/or those who received intravenous immunoglobulin or steroids within the previous 30 days were excluded. We used a multivariable linear regression model, controlling for potential confounders, to assess the association between early steroids and LOS.
Results:
A total of 56 patients hospitalized with MIS-C were identified; 38 received systemic corticosteroids and were included in the study. The mean time from admission to steroid administration was 9.8 hours (SD = 7.7) in the early group and 44.6 hours (SD = 14.2) in the late group. There was a statistically significant difference in baseline characteristics of patients receiving early versus late steroids in initial C-reactive peptide, procalcitonin, brain natriuretic peptide, and cardiac dysfunction. After controlling for confounders, initiating steroids within 24 hours of admission for MIS-C was associated with a decreased hospital LOS: in patients treated with early steroids, LOS was 58.3 hours less (95% confidence interval, -100.0 to -16.6; P = 0.007) than in those who received late steroids.
Conclusions:
Among patients with MIS-C, initiating systemic corticosteroids within 24 hours of admission was associated with decreased hospital LOS.
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