ABSTRACT
BACKGROUND AND AIM: Suggested therapeutic options for Multisystem Inflammatory Syndrome in Children (MIS-C) include intravenous immunoglobulins (IVIG) and steroids. Prior studies have shown the benefit of combination therapy with both agents on fever control or the resolution of organ dysfunction. The objective of this study was to analyze the impact of IVIG and steroids on hospital and ICU length of stay (LOS). METHOD(S): This was a retrospective study on 356 hospitalized MIS-C patients from 03/20-9/21 (28 U.S. sites) in the SCCM Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry. The effect of IVIG and steroids initiated in the first two days of admission, alone or in combination, on LOS was analyzed using intention to treat analysis. Adjustment for confounders was made by multivariable mixed regression with a random intercept for the site. RESULT(S): Median age of the study population was 8.8 (IQR 4.0, 13) years. 247/356 (70%) patients required ICU admission during hospitalization. Of the total patients, 153 (43%) received IVIG and steroids, 33 (9%) received IVIG only, 43 (12%) received steroids only, and 127 (36%) received neither within first two days. After adjustment of confounders, only combination therapy showed a significant decrease of ICU LOS by 1.6 days compared to no therapy (exponentiated coefficient 0.71 [95% CI 0.51, 0.97, p=0.03]). No significant difference was observed in hospital LOS or the secondary outcome variables. CONCLUSION(S): Combination therapy with IVIG and steroids initiated in the first 2 days of admission favorably impacts ICU LOS in children with MIS-C.
ABSTRACT
BACKGROUND AND AIM: Evidence for therapies for pediatric COVID-19 is limited. Primary aim was to study the effect of steroid administration within 2 days of admission for pediatric non-MIS-C-COVID-19 on hospital and ICU length of stay (LOS). The secondary aim was to study its effect on inflammation and fever defervescence. METHOD(S): A retrospective study of 1163 children hospitalized with non-MISC-COVID-19, from 03/20 to 09/21, from 58 hospitals (7 countries, 92% US), in the Viral Infection and Respiratory Illness Universal Study (VIRUS) registry. Effect of steroid administration <= 2 days of admission on hospital and ICU LOS was studied using intention to treat analysis, adjusted for confounders by multivariable mixed linear regression. RESULT(S): Median age was 7(IQR 0.9,14.3) years. 184(15.8%) children who received steroids within <= 2 days were compared to 979 (84.1%) children who did not. 56.5% (n=658) required respiratory support. Patients in the steroid group were older, with higher severity of illness. A greater proportion required respiratory and vasoactive support. On multivariable linear regression with random intercept for site (Table), there was no significant difference in hospital LOS (exponentiated [exp] co-efficient 0.92, 95%CI = 0.77, 1.10, p=0.374) or ICU LOS (exp co-efficient 1.02, 95%CI = 0.78, 1.34, p=0.864) between the groups. There was no significant difference in time to fever defervescence and normalization of inflammatory mediators by Day 3. CONCLUSION(S): In pediatric non-MIS-C COVID-19, steroid treatment <= 2 days of hospital admission did not show a statistically significant effect on hospital or ICU LOS. (Table Presented).