Treatments and severe outcomes for patients diagnosed with MIS-C at four children’s hospitals in the United States, March 16, 2020 – March 10, 2021

Details

• Alternative Title:
  Pediatr Infect Dis J
• Personal Author:
  Shah, Ami B. ; Abrams, Joseph Y. ; Godfred-Cato, Shana ; Kunkel, Amber ; Hammett, Teresa A. ; Perez, Maria A. ; Hsiao, Hui-Mien ; Baida, Nadine ; Rostad, Christina A. ; Ballan, Wassim ; Ede, Kaleo ; Laham, Federico R. ; Kao, Carol M. ; Oster, Matthew E. ; Belay, Ermias D.
• Description:
  Background
  
  Clinical management of multisystem inflammatory syndrome in children (MIS-C) has varied over time and by medical institution.
  
  Methods
  
  Data on patients with MIS-C were collected from four children’s hospitals between March 16, 2020 – March 10, 2021. Relationships between MIS-C treatments and patient demographics, clinical characteristics, and outcomes were described. Propensity score matching was utilized to assess the relative risk of outcomes dependent on early treatment with intravenous immunoglobulin (IVIG) or low-dose steroids, controlling for potential confounding variables.
  
  Results
  
  Out of 233 patients diagnosed with MIS-C, the most commonly administered treatments were steroids (88.4%), aspirin (81.1%), IVIG (77.7%), and anticoagulants (71.2%). Compared with those patients without respiratory features, patients with respiratory features were less likely to receive IVIG and steroids on the same day (combination treatment) (44.1%). Controlling for confounding variables, patients receiving IVIG within one day of hospitalization were less likely to have hospital length of stay (LOS) ≥8 days (RR = 0.53, 95% CI = 0.31–0.88). Patients receiving low-dose steroids within one day of hospitalization were less likely to develop ventricular dysfunction (RR = 0.45, 95% CI = 0.26–0.77), have increasingly elevated troponin levels (RR = 0.55, 95% CI = 0.40–0.75), or have hospital LOS ≥8 days (RR = 0.46, 95% CI = 0.29–0.74).
  
  Conclusion
  
  Treatments for MIS-C differed by hospital, patient characteristics, and illness severity. When IVIG and low-dose steroids were administered in combination or low-dose steroids were administered alone within 1 day of hospitalization, risk of subsequent severe outcomes was decreased.
  
  
• Subjects:
  Child COVID-19 Hospitals Humans Immunoglobulins, Intravenous Steroids Systemic Inflammatory Response Syndrome United States
• Keywords:
  MIS-C Multisystem Inflammatory Syndrome In Children Pediatric PIMS Treatments
• Source:
  Pediatr Infect Dis J. 42(11):990-998
• Pubmed ID:
  37862698
• Pubmed Central ID:
  PMC11318085
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  42
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:3675f443e72a30da1c63b3110e3e77554715fe186f9103ed8a87d90fbc273cdb86b5ab476e3c69c3fb368780080f901eb5bc4e8ca05ef6456edb102881aac632
• Download URL:
  https://stacks.cdc.gov/view/cdc/159822/cdc_159822_DS1.pdf
• File Type:
  [PDF - 1.72 MB ]