Clinical Profile and Short-Term Outcome of Children with SARS-CoV-2 Related Multisystem Inflammatory Syndrome(MIS-C) Treated with Pulse Methylprednisolone

ABSTRACT

BACKGROUND: Multi system inflammatory syndrome in children (MIS-C) is a rare, but life-threatening complication of SARS-CoV-2 infection. OBJECTIVES: To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and /or IVIG. STUDY DESIGN: Observational study. PARTICIPANTS: Children satisfying CDC MIS-C criteria admitted during the study period. OUTCOME MEASURES: Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy. Secondary outcomes included duration of ICU stay, mortality, need for repeat immunomodulation, time to normalization of CRP and persistence of coronary abnormalities at 2 weeks. RESULTS: Study population included 32 patients with MIS-C with median (IQR) age of 7.5 (5-9.5) years. The proportion of children with gastrointestinal symptoms was 27 (84%), cardiac was 29 (91%) and coronary artery dilatation was 11 (34%). Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 (81%), and 6 (19%) patients, respectively. Treatment failure was observed in 2/26 patients in methylprednisolone group and 2/6 patients in IVIG group. C-reactive protein levels less than 60mg/L by day 3 was seen in 17(74%) in methylprednisolone group and 2 (25%) in IVIG group (P=0.014). There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group. CONCLUSIONS: In patients with SARS-CoV-2 related MIS-C, methylprednisolone pulse therapy was associated with favorable short-term outcomes.