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Topics in Antiviral Medicine ; 30(1 SUPPL):297, 2022.
Article in English | EMBASE | ID: covidwho-1879886


Background: We aimed to analyse the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, probability of switching to second-line treatment over time, and persistent fever after 2 days of treatment. Methods: We did a retrospective study to investigate the effect of treatments (IVIG plus steroids, steroids alone or IVIG alone) of children with MIS-C in a nationwide study, from 1 March to 1 June 2021. We used a Markovian multi-state model with the clock-forward approach and unidirectional arrows to build a multi-state model. Three transitions were defined: initiation of treatment to hospital discharge (t1), initiation of treatment to second-line therapy (t2), and second-line therapy to hospital discharge (t3). A treatment was considered as second-line if initiated >2 days after the first therapy. We estimated the time-to-event probability using a Cox model weighted by the propensity score to balance the baseline characteristics. Results: 30/132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p=0.013), but with a higher probability of needing second-line therapy versus IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p=0.028). Patients on steroids had a lower probability of persistent fever after 2 days of treatment (odds ratio [OR] 0.55, 95% CI, 0.28-1.05, p=0.081) versus patients on IVIG plus steroids, and those on the combination had with a lower probability versus IVIG alone (OR 0.21, 95% CI, 0.09-0.46, p=0.0001). We also directly compared the IVig-and steroid-alone treatments. The probability of early discharge of the patients on steroids and on IVig were not different (HR 0·58, 95% CI 0·27-1·24, p=0·166). The probability of transition second-line therapy was also similar (HR 0·71, 95% CI 0·29-1·74, p=0·456). IVIG had a 4-fold higher probability of persistent fever after treatment initiation than steroids (OR 4·23 95% CI 1·43-13·5, p=0·011). Conclusion: IVIG seemed to increase the probability of discharge over time but increased the probability of needing second-line treatment over time. Steroids seemed to reduce persistent fever after 2 days of treatment, and combination therapy reduced the need for escalating treatment.

Topics in Antiviral Medicine ; 30(1 SUPPL):330-331, 2022.
Article in English | EMBASE | ID: covidwho-1880604


Background: Testing using nasopharyngeal swabs (NPS) samples is the cornerstone for the control of the COVID-19 pandemic, but the procedure is uncomfortable and generates anxiety, especially in children. We aimed to evaluate the adequacy of oral saliva swab analysis using RT-PCR comparing to NPS by RT-PCR and Antigen Rapid Test (AgRT) on NPS in children. Methods: Cross-sectional multicenter diagnostic study nested in a prospective, observational cohort (EPICO-AEP) carried out between February and March 2021 at 10 hospitals in Spain. Participants were children 0 to 18 years old with symptoms compatible with SARS-CoV-2 infection of ≤5 days of duration attending at emergency departments. Three samples were collected, two NPS (for AgRT and for RT-PCR) and one oral saliva swab for RT-PCR. In patients with discordant results, new NPS was collected for viral culture and original samples were tested for viral RNA subgenomic (sgRNA) study. Results: 1174 children were included in the analysis, aged 3.8 years (IQR, 1.7-9.0), 647/1174 (55.1%) were male and 760/1174 (64.7%) presented fever 1 day before emergency department admission (IQR 1.0-2.0). Overall, 73/1174 (6.2%) patients tested positive in at least one of the techniques. Sensitivity for RT-PCR in oral saliva swab was 72.1% (95%CI, 59.7-81.9) and specificity 99.6% (95%CI, 99.0-99.9);AgRT in NPS was 61.8% (95%CI, 49.1-73.0) and 99.9% (95%CI, 99.4-100). Kappa index for RT-PCR oral saliva swab was 0.80 (95%CI, 0.72-0.88), and for AgRT was 0.74 (95%CI, 0.65-0.84) vs RT-PCR in NPS. A Bayesian model was used to estimate the accuracy assuming that RT-PCR in NPS is not a perfect gold standard. In this model, sensitivity for RT-PCR oral saliva swab was 84.8% (95%Cr 71.5-93.6), and for AgRT, it was 72.5% (95%Cr, 58.8-83.6). Specificity for RT-PCR oral saliva swab was 99.7% (95%Cr, 99.2-99.9), and for AgRT it was 99.9% (95% Cr, 99.6-100). The Cts were higher in oral saliva swabs compared with NPS;being Ct (NPS)=0.5 x (Ct saliva) + 4.5 (p=0.027). Overall, 4 (10.8%) patients with discordant results had a positive culture. In 3 of the 4 patients, the discordance consisted of positive result on oral saliva swab and nasopharyngeal swabs RT-PCR but negative by antigen rapid diagnostic test. No patient had (+) culture, (+)NP, (-)oral swab. Conclusion: RT-PCR on oral saliva swab is an accurate option for SARS-CoV-2 testing in children. A friendlier technique for younger patients, who must be tested very frequently, may help to increase the number of patients tested.