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Plasma IL-17A is increased in patients with critical MIS-C and associated to in-hospital mortality
Emmerson C F de Farias1, Luciana M P P do Nascimento1, Manoel J C Pavão Junior1
1Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil.
Insights
Elevated Interleukin-17A (IL-17A) levels in children with Multisystem Inflammatory Syndrome (MIS-C) correlate with increased mortality risk. Early identification of high IL-17A may aid in managing critical MIS-C cases.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Infectious disease epidemiology
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe post-COVID-19 complication.
- MIS-C presents with diverse clinical manifestations.
- Understanding MIS-C pathogenesis is crucial for improving outcomes.
Purpose of the Study:
- To investigate inflammatory biomarkers, specifically cytokines and oxidative stress markers, in critically ill MIS-C patients.
- To determine the association between these biomarkers and mortality in MIS-C.
Main Methods:
- A prospective, single-center study included 41 MIS-C patients (1 month to 18 years) admitted to a pediatric intensive care unit (PICU).
- Inflammatory biomarkers were measured on days 1 and 3 post-hospitalization.
- Survival analysis utilized Kaplan-Meier curves and Cox regression, with ROC analysis for predictive values.
Main Results:
- 16 out of 41 MIS-C patients (39%) did not survive.
- Higher levels of Interleukin-17A (IL-17A) on day 1 were significantly associated with increased mortality (p=0.012).
- An IL-17A cutoff of 14.32 pg/mL predicted mortality, while other markers showed no significant association.
Conclusions:
- Elevated IL-17A levels on day 1 of hospitalization are a significant predictor of mortality in critically ill MIS-C patients.
- IL-17A may serve as a potential therapeutic target or prognostic marker in MIS-C.
- Further research is warranted to explore the role of IL-17A in MIS-C pathophysiology and treatment.
Background:
Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe post-COVID-19 complication with multiple phenotypes.
Objectives:
The aim of this study is to study inflammatory biomarkers (cytokines and oxidative stress) in critical MIS-C patients and to observe if there is association between these biomarkers and mortality.
Methods:
A single-center prospective study enrolled patients with MIS-C (with positive molecular test), aged between 1 month and 18 years of age. Data was collected from 20 pediatric intensive care unit (PICU)'s bed. Inflammatory biomarkers (cytokines and oxidative stress markers) were performed on day 1 and 3 after hospitalization. Survival rate was calculated, and Kaplan-Meier curves were plotted. Univariate and multivariate Cox regression analyses were conducted. The ROC (Receiver Operating Characteristic) curve analysis was performed.
Results And Conclusions:
A total of 41 patients out of 109 patients admitted at PICU with suspected MIS-C during the study period were included, of which 33 (80.5%) were male, 9 (22%) were under one year old, and 30 (73.2%) presented comorbidities. Among them, 16 (39%) did not survive. The mean survival time was shorter in patients with higher levels of IL-17A (≥ 19.71 pg/mL) on day 1 (115 vs 323 days, p = 0.004). Higher levels of IL-17A on day 1 were associated with mortality in both the crude model (HR 1.03, CI95% 1.004-1.057, p = 0.022) and the adjusted model (HR 1.043, CI95% 1.013-1.075, p = 0.012). ROC analysis revealed a cut-off value for the IL-17A of 14.32 pg/ml. The other immunological and inflammatory markers did not demonstrate an association with survival (p>0.05). Our findings suggest that patients with high levels of IL-17A are at greater risk for death.
