Early Combination Therapy with Immunoglobulin and Steroids Is Associated with Shorter Icu Length of Stay in Multisystem Inflammatory Syndrome in Children Associated with Covid19

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.