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Early combination therapy with immunoglobulin and steroids is associated with shorter ICU length of stay in Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19: A retrospective cohort analysis from 28 U.S. Hospitals.
Harthan, Aaron A; Nadiger, Meghana; McGarvey, Jeremy S; Hanson, Keith; Gharpure, Varsha P; Bjornstad, Erica C; Chiotos, Kathleen; Miller, Aaron S; Reikoff, Ronald A; Gajic, Ognjen; Kumar, Vishakha; Walkey, Allan J; Kashyap, Rahul; Tripathi, Sandeep.
  • Harthan AA; Department of Clinical Pharmacy, OSF Healthcare Children's Hospital of Illinois, Peoria, Illinois, USA.
  • Nadiger M; Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.
  • McGarvey JS; Healthcare Analytics, OSF Healthcare, Peoria, Illinois, USA.
  • Hanson K; Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.
  • Gharpure VP; Advocate Children's Hospital, Park Ridge, Illinois, USA.
  • Bjornstad EC; University of Alabama at Birmingham, Birmingham, Alabama, USA.
  • Chiotos K; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
  • Miller AS; Cardinal Glennon Children's Hospital, St Louis, Missouri, USA.
  • Reikoff RA; M Health-Fairview, University of Minnesota, Minneapolis, Minnesota, USA.
  • Gajic O; Mayo Clinic, Rochester, Minnesota, USA.
  • Kumar V; Society of Critical Care Medicine, Chicago, IL, USA.
  • Walkey AJ; The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
  • Kashyap R; Mayo Clinic, Rochester, Minnesota, USA.
  • Tripathi S; Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.
Pharmacotherapy ; 42(7): 529-539, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1905929
ABSTRACT

OBJECTIVES:

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 primary objective of this study was to analyze the impact of IVIG and steroids on hospital and ICU length of stay (LOS) in patients with MIS-C associated with Coronavirus Disease 2019 (COVID-19). STUDY

DESIGN:

This was a retrospective study on 356 hospitalized patients with MIS-C from March 2020 to September 2021 (28 sites in the United States) in the Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry. The effect of IVIG and steroids initiated in the first 2 days of admission, alone or in combination, on LOS was analyzed. Adjustment for confounders was made by multivariable mixed regression with a random intercept for the site.

RESULTS:

The median age of the study population was 8.8 (Interquartile range (IQR) 4.0, 13) years. 247/356 (69%) patients required intensive care unit (ICU) admission during hospitalization. Overall hospital mortality was 2% (7/356). 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 2 days of admission. 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% confidence interval 0.51, 0.97, p = 0.03]). No significant difference was observed in hospital LOS or the secondary outcome variable of the normalization of inflammatory mediators by Day 3.

CONCLUSIONS:

Combination therapy with IVIG and steroids initiated in the first 2 days of admission favorably impacts ICU but not the overall hospital LOS in children with MIS-C.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Etiology study / Incidence study / Observational study / Randomized controlled trials / Risk factors Topics: Long Covid Limits: Child / Humans Country/Region as subject: North America Language: English Journal: Pharmacotherapy Year: 2022 Document Type: Article Affiliation country: Phar.2709

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Etiology study / Incidence study / Observational study / Randomized controlled trials / Risk factors Topics: Long Covid Limits: Child / Humans Country/Region as subject: North America Language: English Journal: Pharmacotherapy Year: 2022 Document Type: Article Affiliation country: Phar.2709