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 COVID19: A retrospective cohort analysis from 28 U.S Hospitals

Authors

Aaron Harthan, Department of Clinical Pharmacy, OSF Healthcare Children's Hospital of Illinois, Peoria, Illinois, USA.
Meghana Nadiger, Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.
Jeremy S. McGarvey, Healthcare analytics, OSF Healthcare, Peoria, Illinois, USA.
Keith Hanson, Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.
Varsha P. Gharpure, Advocate Aurora HealthFollow
Erica C. Bjornstad, University of Alabama at Birmingham, AL, USA.Follow
Kathleen Chiotos, Children's Hospital of Philadelphia, Philadelphia, PA, USA.Follow
Aaron S. Miller, Cardinal Glennon Children's Hospital, St Louis, MO, USA.
Ronald A. Reikoff, M Health-Fairview, University of Minnesota, MN, USA.
Ognjen Gajic, Mayo Clinic, Rochester, MN, USA.
Vishakha Kumar, Society of Critical Care Medicine, Chicago, IL, USA.
Allan Walkey, Department of Medicine, Boston University School of Public Health, Boston, Massachusetts, USA.
Rahul Kashyap, Mayo Clinic, Rochester, MN, USA.
Sandeep Tripathi, Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.

Recommended Citation

Harthan AA, Nadiger M, McGarvey JS, et al. 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. Pharmacotherapy. 2022;42(7):529-539. doi:10.1002/phar.2709

Affiliations

Advocate Children's Hospital

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: 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.

Document Type

Article

PubMed ID

35661394