Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies
Por:
Tagarro A, Domínguez-Rodríguez S, Mesa JM, Epalza C, Grasa C, Iglesias-Bouzas MI, Fernández-Cooke E, Calvo C, Villaverde S, Torres-Fernández D, Méndez-Echevarria A, Leoz I, Fernández-Pascual M, Saavedra-Lozano J, Soto B, Aguilera-Alonso D, Rivière JG, Fumadó V, Martínez-Campos L, Vivanco A, Pilar-Orive FJ, Alcalá P, Ruiz B, López-Machín A, Oltra M and Moraleda C
Publicada:
1 ene 2023
Ahead of Print:
1 oct 2022
Categoría:
Pediatrics, perinatology and child health
Resumen:
Scarceevidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and the persistence of fever 2 days after treatment. We did a retrospective study to investigate the effect of different treatments on children with MIS-C from 1 March 2020 to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Thirty of 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 compared to IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p= 0.028). Patients on IVIG had a higher likelihood of persistent fever than patients on steroids (odds ratio [OR] 4.23, 95% CI 1.43-13.5, p =0 .011) or on IVIG plus steroids (OR 4.4, 95% CI 2.05-9.82, p < 0.001). No differences were found for this endpoint between steroids or steroids plus IVIG.
Conclusions: The benefits of each approach may vary depending on the outcome assessed. IVIG seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever, and combination therapy reduced the need for escalating treatment.
Filiaciones:
Tagarro A:
Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain.
RITIP (Translational Research Network On Paediatric Infectious Diseases), Madrid, Spain.
Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain.
Domínguez-Rodríguez S:
Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
Mesa JM:
Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain
Paediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
Epalza C:
Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
Universidad Complutense de Madrid, Madrid, Spain
Grasa C:
Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
CIBER en Enfermedades Infecciosas (CIBERINFEC), RITIP (Translational Research Network On Paediatric Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain
Iglesias-Bouzas MI:
Paediatrics Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
Fernández-Cooke E:
Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
Calvo C:
Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
CIBER en Enfermedades Infecciosas (CIBERINFEC), RITIP (Translational Research Network On Paediatric Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain
Villaverde S:
Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
Torres-Fernández D:
Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
Méndez-Echevarria A:
Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
Leoz I:
Paediatrics Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
Fernández-Pascual M:
Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain
Saavedra-Lozano J:
Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
Soto B:
Paediatrics Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain
Aguilera-Alonso D:
Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
Rivière JG:
Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Fumadó V:
Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu, Barcelona, Spain
Martínez-Campos L:
Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Torrecárdenas, Almeria, Spain
Vivanco A:
Paediatrics Intensive Care Unit, Hospital Central de Asturias, Asturias, Spain
Pilar-Orive FJ:
Paediatrics Department, Hospital Universitario de Cruces, Barakaldo, Spain
Alcalá P:
Paediatrics Department, Hospital General de Alicante, Alicante, Spain
Ruiz B:
Paediatrics Department, Hospital Reina Sofía, Córdoba, Spain
López-Machín A:
Paediatrics Department, Hospital Son Espasses, Palma, Spain
Oltra M:
Paediatrics Department, Hospital La Fe, Valencia, Spain
Moraleda C:
Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
Green Submitted, Green Accepted
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