Clinical Profile and Short-Term Outcome of Children With SARS-CoV-2 Related Multisystem Inflammatory Syndrome (MIS-C) Treated With Pulse Methylprednisolone

Sugunan, Sheeja; Sasidharan, Bindusha; Geetha, Selvaraj; Niyas, H. R.; Kumar, Arun

doi:10.1007/s13312-021-2277-4

Cited by 20 publications

(28 citation statements)

References 21 publications

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“…The majority of studies reporting long-term follow-up of children with MIS-C are from developed countries, 10 – 16 and there is lack of such data from the Indian subcontinent. In this retrospective study from North India, we described the follow-up of 34 children with MIS-C who were admitted during the first wave of SARS-CoV-2 infection and demonstrated that majority of the children were asymptomatic and myocardial dysfunction and coronary artery changes resolved in majority during follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Multisystem Inflammatory Syndrome in Children: Follow-Up of a Cohort from North India

Awasthi

Kumar

Naganur

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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Multisystem inflammatory syndrome in children (MIC-S) is a hyperinflammatory manifestation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Information on the long-term outcome of MIS-C is limited. This study was conducted to describe the long-term outcome of MIS-C from a tertiary care center in North India. Children admitted with MIS-C from September 2020 to January 2021 were followed up after discharge until June 2021. The details during the acute phase (clinical features, investigations, treatment, and outcome) and follow-up (symptoms, echocardiographic findings, ongoing treatment, and outcome) were collected retrospectively. During the acute phase, 40 children presented at median (interquartile range [IQR]) age of 7 (5–10) years with fever, mucocutaneous, gastrointestinal, and respiratory symptoms. The majority (66.7%) of the children had positive SARS-CoV-2 serology and elevated inflammatory markers (C-reactive protein, procalcitonin, ferritin, D-dimer, and fibrinogen), lymphopenia, and thrombocytopenia. Eighty percent had shock, 72.5% had myocardial dysfunction (left ventricular ejection fraction <55%), and 22.5% had coronary artery dilatation or aneurysm. Treatment included pediatric intensive care unit admission (85%), intravenous immunoglobulin (100%), steroids (85%), aspirin (80%), vasoactive drugs (72.5%), and invasive mechanical ventilation (22.5%). Two (5%) children died because of refractory shock. Thirty-four children were followed up with until a median (IQR) of 5 (3–6) months. During the follow-up, a majority were asymptomatic, myocardial function returned to normal in all, and only one had coronary artery aneurysm. Prednisolone and aspirin were given for a median (IQR) of 3 (2–4) weeks and 4 (4–6) weeks after discharge, respectively. There was one readmission and no death during the follow-up. To conclude, the long-term outcome of MIS-C is generally favorable with resolution of cardiovascular manifestations (myocardial dysfunction and coronary artery changes) in the majority of children during follow-up.

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Section: Discussionmentioning

confidence: 99%

“…Information on the long-term outcome of MIS-C is limited to a few studies from developed countries. 10 – 16 Therefore, we planned this follow-up study to describe the clinical features, echocardiographic findings, and long-term outcome of children with MIS-C from a tertiary care center in North India.…”

Section: Introductionmentioning

confidence: 99%

Multisystem Inflammatory Syndrome in Children: Follow-Up of a Cohort from North India

Awasthi

Kumar

Naganur

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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“…A cohort study [ 47 ] with 32 patients also compared glucocorticoids ( n = 26) alone with IVIG alone ( n = 6). Two patients each in glucocorticoids group and IVIG group failed treatment (very low quality evidence).…”

Section: Resultsmentioning

confidence: 99%

“…Current guidelines also indicate a lack of high-quality studies comparing IVIG with glucocorticoids in MIS-C [ 58 – 61 ]. Different from the aforementioned three studies, two studies compared glucocorticoid-only with IVIG-only and the results provided modest evidence of benefit with glucocorticoids alone over IVIG alone [ 46 , 47 ]. However, when expanding the range of patients to MIS-C and also those with any suspected inflammatory illness after SARS-CoV-2 infection, the data showed no differences between treatment with glucocorticoids or IVIG as single agents or between the single-agent and dual-agent treatments [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Potentially effective drugs for the treatment of COVID-19 or MIS-C in children: a systematic review

et al. 2022

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The purpose of this systematic review is to evaluate the efficacy and safety of using potential drugs: remdesivir and glucocorticoid in treating children and adolescents with COVID-19 and intravenous immunoglobulin (IVIG) in treating MIS-C. We searched seven databases, three preprint platform, ClinicalTrials.gov, and Google from December 1, 2019, to August 5, 2021, to collect evidence of remdesivir, glucocorticoid, and IVIG which were used in children and adolescents with COVID-19 or MIS-C. A total of nine cohort studies and one case series study were included in this systematic review. In terms of remdesivir, the meta-analysis of single-arm cohort studies have shown that after the treatment, 54.7% (95%CI, 10.3 to 99.1%) experienced adverse events, 5.6% (95%CI, 1.2 to 10.1%) died, and 27.0% (95%CI, 0 to 73.0%) needed extracorporeal membrane oxygenation or invasive mechanical ventilation. As for glucocorticoids, the results of the meta-analysis showed that the fixed-effect summary odds ratio for the association with mortality was 2.79 (95%CI, 0.13 to 60.87), and the mechanical ventilation rate was 3.12 (95%CI, 0.80 to 12.08) for glucocorticoids compared with the control group. In terms of IVIG, most of the included cohort studies showed that for MIS-C patients with more severe clinical symptoms, IVIG combined with methylprednisolone could achieve better clinical efficacy than IVIG alone.Conclusions: Overall, the current evidence in the included studies is insignificant and of low quality. It is recommended to conduct high-quality randomized controlled trials of remdesivir, glucocorticoids, and IVIG in children and adolescents with COVID-19 or MIS-C to provide substantial evidence for the development of guidelines. What is Known:• The efficacy and safety of using potential drugs such as remdesivir, glucocorticoid, and intravenous immunoglobulin (IVIG) in treating children and adolescents with COVID-19/MIS-C are unclear. What is New:• Overall, the current evidence cannot adequately demonstrate the effectiveness and safety of using remdesivir, glucocorticoids, and IVIG in treating children and adolescents with COVID-19 or MIS-C.• We are calling for the publication of high-quality clinical trials and provide substantial evidence for the development of guidelines.

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“…To the Editor: Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening complication of COVID-19 that may occur during or after recovery from acute infection [ 1 ]. Very limited clinical data are available on MIS-C from India till date [ 2 , 3 ]. This prospective observational study was conducted in a tertiary care pediatric hospital of South India to describe the clinical presentation of children with MIS-C. Seventy-four children below 12 y of age who satisfied the World Health Organization’s diagnostic criteria for MIS-C were included in the study [ 4 ].…”

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confidence: 99%

Clinical Spectrum of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 Infection

et al. 2022

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Clinical Profile and Short-Term Outcome of Children With SARS-CoV-2 Related Multisystem Inflammatory Syndrome (MIS-C) Treated With Pulse Methylprednisolone

Cited by 20 publications

References 21 publications

Multisystem Inflammatory Syndrome in Children: Follow-Up of a Cohort from North India

Multisystem Inflammatory Syndrome in Children: Follow-Up of a Cohort from North India

Potentially effective drugs for the treatment of COVID-19 or MIS-C in children: a systematic review

Clinical Spectrum of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 Infection

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