Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies.

Autor: Tagarro A; Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain. alfredotagarro@gmail.com.; RITIP (Translational Research Network On Paediatric Infectious Diseases), Madrid, Spain. alfredotagarro@gmail.com.; Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain. alfredotagarro@gmail.com., 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.
Jazyk: angličtina
Zdroj: European journal of pediatrics [Eur J Pediatr] 2023 Jan; Vol. 182 (1), pp. 461-466. Date of Electronic Publication: 2022 Oct 25.
DOI: 10.1007/s00431-022-04649-8
Abstrakt: Scarce evidence 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. What is Known: • Steroids plus intravenous immunoglobulin, compared with intravenous immunoglobulin alone for multi-system inflammatory syndrome (MIS-C) might reduce the need for hemodynamic support and the duration of fever, but the certainty of the evidence is low. What is New: • Intravenous immunoglobulin, steroids, and their combination for MIS-C may have different outcomes. • In this study, intravenous immunoglobulin increased the probability of discharge over time, steroids reduced persistent fever, while combination therapy reduced the need for second-line treatments.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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