J Pediatr Infect Dis 2022; 17(05): 234-241
DOI: 10.1055/s-0042-1755210
Original Article

Factors Associated with Pulse Methylprednisolone Treatment Failure in COVID-19-Related Multisystem Inflammatory Syndrome in Children (MIS-C)

1   Department of Paediatrics, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
,
2   SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
,
H. R. Niyas
2   SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
,
S. Geetha
2   SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
,
R V Chinchilu
2   SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
› Author Affiliations

Abstract

Objective This article determines the occurrence and variables associated with pulse methylprednisolone treatment failure in children with coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C).

Methods This prospective observational study was undertaken at a tertiary care teaching hospital in Kerala, India. Children admitted with COVID-19-related MIS-C who were treated with pulse methylprednisolone as first-line therapy were included in the study. Depending on the response to the treatment, they were divided into two groups. The clinical, laboratory parameters, and follow-up findings at 3 months were compared between the two groups

Results Seventy-six patients were admitted with MIS-C during the study period. Sixty received pulse methylprednisolone as the first-line therapy. Of the 60 patients who received pulse methylprednisolone, 50 responded to treatment, while 10 required repeat immunomodulation. Need for noninvasive or invasive ventilation (relative risk [RR]: 13.14, 95% confidence interval [CI]: 3.147–54.88), six or more organ involvement (RR: 4.667, 95% CI: 1.349–16.149), thrombocytopenia (RR: 6.43, 95% CI: 0.87–47.6, p 0.003), and abnormal chest X-ray findings at admission (RR: 4.5, 95% CI: 1.46–13.8), were found to be associated with increased risk of treatment failure with pulse methylprednisolone therapy. Note that 88% of patients with coronary artery involvement showed resolution at 3-month follow-up.

Conclusion More than 80% of children with MIS-C can be treated successfully with corticosteroids. The need for ventilator support, abnormal chest X-ray findings, and thrombocytopenia at admission were found to be factors associated with pulse methylprednisolone treatment failure.

Ethical Approval

The study was approved by the institutional ethical committee. Information form validated by the ethics committee was provided to all participants. Informed written consent was obtained from all study participants. The study is an interim analysis of an ongoing study in the department.


Authors' Contributions

S.S. conceptualized the study and drafted the manuscript. B.S. conducted statistical analysis and revision of the manuscript for intellectual content. N.H.R. performed data acquisition and drafting of the manuscript. G.S. conducted statistical analysis and critical revision of the manuscript. C.R.V. contributed to the revision of the manuscript for intellectual content. All authors approved the version for final publication.




Publication History

Received: 22 March 2022

Accepted: 31 May 2022

Article published online:
13 September 2022

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  • References

  • 1 Feldstein LR, Tenforde MW, Friedman KG. et al; Overcoming COVID-19 Investigators. Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. JAMA 2021; 325 (11) 1074-1087
  • 2 Godfred-Cato S, Bryant B, Leung J. et al; California MIS-C Response Team. COVID-19-associated multisystem inflammatory syndrome in children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (32) 1074-1080
  • 3 Vukomanovic V, Krasic S, Prijic S. et al. Recent experience: corticosteroids as a first-line therapy in children with multisystem inflammatory syndrome and COVID-19-related myocardial damage. Pediatr Infect Dis J 2021; 40 (11) e390-e394
  • 4 Ouldali N, Toubiana J, Antona D. et al; French Covid-19 Paediatric Inflammation Consortium. Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children. JAMA 2021; 325 (09) 855-864
  • 5 CDC. Multisystem Inflammatory Syndrome in Children (MIS-C) [Internet]. Centres for Disease Control and Prevention. 2020 . Accessed February 3, 2021 at: https://www.cdc.gov/mis-c/hcp/.
  • 6 McCrindle BW, Rowley AH, Newburger JW. et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017; 135 (17) e927-e999
  • 7 Kerala-state-Covid-19-Treatment-guidelines-V4-August-5.pdf [Internet]. Accessed November 7, 2021 at: https://dhs.kerala.gov.in/wp-content/uploads/2021/08/Kerala-state-Covid-19-Treatment-guidelines-V4-August-5.pdf
  • 8 Payne AB, Gilani Z, Godfred-Cato S. et al; MIS-C Incidence Authorship Group. Incidence of multisystem inflammatory syndrome in children among US persons infected with SARS-CoV-2. JAMA Netw Open 2021; 4 (06) e2116420
  • 9 Shekerdemian LS, Mahmood NR, Wolfe KK. et al; International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr 2020; 174 (09) 868-873
  • 10 Belot A, Antona D, Renolleau S. et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020. Euro Surveill 2020; 25 (22) 2001010
  • 11 Davies P, Lillie J, Prayle A. et al. Association between treatments and short-term biochemical improvements and clinical outcomes in post-severe acute respiratory syndrome coronavirus-2 inflammatory syndrome. Pediatr Crit Care Med 2021; 22 (05) e285-e293
  • 12 Dhanalakshmi K, Venkataraman A, Balasubramanian S. et al. Epidemiological and clinical profile of pediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS) in Indian children. Indian Pediatr 2020; 57 (11) 1010-1014
  • 13 McArdle AJ, Vito O, Patel H. et al; BATS Consortium. Treatment of multisystem inflammatory syndrome in children. N Engl J Med 2021; 385 (01) 11-22
  • 14 Jonat B, Gorelik M, Boneparth A. et al. Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 in a children's hospital in New York City: patient characteristics and an institutional protocol for evaluation, management, and follow-up. Pediatr Crit Care Med 2021; 22 (03) e178-e191
  • 15 Belhadjer Z, Auriau J, Méot M. et al. Addition of corticosteroids to immunoglobulins is associated with recovery of cardiac function in multi-inflammatory syndrome in children. Circulation 2020; 142 (23) 2282-2284
  • 16 Son MBF, Murray N, Friedman K. et al; Overcoming COVID-19 Investigators. Multisystem inflammatory syndrome in children - initial therapy and outcomes. N Engl J Med 2021; 385 (01) 23-34
  • 17 Sugunan S, Bindusha S, Geetha S, Niyas HR, Kumar AS. Clinical profile and short-term outcome of children with SARS-CoV-2 related multisystem inflammatory syndrome (MIS-C) treated with pulse methylprednisolone. Indian Pediatr 2021; 58 (08) 718-722
  • 18 Daniels SR, Specker B, Capannari TE, Schwartz DC, Burke MJ, Kaplan S. Correlates of coronary artery aneurysm formation in patients with Kawasaki disease. Am J Dis Child 1987; 141 (02) 205-207
  • 19 Davies P, Evans C, Kanthimathinathan HK. et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health 2020; 4 (09) 669-677
  • 20 Abrams JY, Oster ME, Godfred-Cato SE. et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. Lancet Child Adolesc Health 2021; 5 (05) 323-331