Abstract
Background: Multisystem inflammatory syndrome (MIS-C) is a condition related to COVID-19. It’s most significant feature is cardiac involvement. Methods: We have analyzed data from 42 hospitals in the Polish MIS-C Registry. To compare the effect of GCS on fever, we formed two groups: the first treated with IVIG and the second treated with IVIG+GCS. Results: There were 111 boys and 56 girls; the mean age was 8.57 years. All the patients were treated with IVIG: 76 patients with IVIG only, and 91 patients with IVIG+GCS. There were no statistically significant differences between the groups regarding age, gender, BMI, or inflammatory markers. Methylprednisolone was the most common drug (80%). Echocardiographic abnormalities on admission were more prevalent in the IVIG+GCS group. Mean time from IVIG infusion to subsidence of fever was 1.1 days, and 1.5 for those in the IVIG+GCS group. Conclusions: GCS are commonly used in the treatment of MIS-C patients in Poland. Various GCS regimens are used, from a single dose to a month-long therapy. Children with lower lymphocyte levels and cardiac abnormalities on an echocardiographic examination performed on admission were more likely to receive GCS+IVIG. The effect of GCS is difficult to access as patients were not randomly assigned to receive the treatment.
Highlights
Multisystem inflammatory syndrome (MIS-C) is a condition related to COVID-19
MIS-C was diagnosed based on the published guidelines from the Royal College of Pediatrics and Child Health, World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC) [7,8,9]
The case definition of MIS-C included six criteria: serious illness leading to hospitalization, an age of fewer than 21 years, fever or report of subjective fever lasting at least 24 h, laboratory evidence of inflammation, multisystem organ involvement, and laboratory-confirmed SARS-CoV-2 infection (positive SARS-CoV-2 real-time reversetranscriptase–polymerase-chain-reaction (RT-PCR) or antibody test during hospitalization) or an epidemiological link to a person with suspected or confirmed COVID-19 within four weeks before the onset of MIS-C symptoms
Summary
Multisystem inflammatory syndrome (MIS-C) is a condition related to COVID-19. The first cases of MIS-C reported in EU/EEA countries and the UK were in spring 2020 [1,2,3,4]. Epidemiological data reveal that MIS-C occurred 3–8 weeks after exposure to SARS-CoV-2. Newburger found that primary therapy with pulsed intravenous methylprednisolone, administered as a single dose of 30 mg per kilogram before conventional treatment with IVIG (2 g per kilogram), did not improve coronary-artery outcomes at week one or week five after study enrollment [12]. According to a Post-RAISE study, a primary IVIG and prednisolone combination therapy might prevent coronary artery abnormalities [14]. Meta-analysis of 16 comparative studies involving KD patients demonstrated that the early addition of GCS to conventional IVIG therapy is associated with a reduced risk of cardiac complications. We wanted to analyze the role of GCS in the treatment of Polish MIS-C patients. The effect of GCS was checked based on the duration of fever after the introduction of the treatment
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