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Treatment of Multisystem Inflammatory Syndrome in Children
- Source :
- The New England Journal of Medicine, The New England journal of medicine, The New England journal of medicine, vol 385, iss 1, NEW ENGLAND JOURNAL OF MEDICINE, New England Journal of Medicine, 385(1), 11-22. Massachussetts Medical Society, New England Journal of Medicine
- Publication Year :
- 2021
- Publisher :
- Massachusetts Medical Society, 2021.
-
Abstract
- BackgroundEvidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2.MethodsWe performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation.ResultsData were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups.ConclusionsWe found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue. (Funded by the European Union's Horizon 2020 Program and others; BATS ISRCTN number, ISRCTN69546370.).
- Subjects :
- Inotrope
Male
medicine.medical_treatment
2700 General Medicine
030204 cardiovascular system & hematology
Antibodies, Viral
Medical and Health Sciences
Cohort Studies
0302 clinical medicine
Glucocorticoid
hemic and lymphatic diseases
Medicine and Health Sciences
030212 general & internal medicine
Viral
Child
11 Medical and Health Sciences
OUTCOMES
Respiration
Immunoglobulins, Intravenous
General Medicine
Systemic Inflammatory Response Syndrome
3. Good health
Hospitalization
Treatment Outcome
Child, Preschool
Combination
Artificial
Regression Analysis
Drug Therapy, Combination
Female
Original Article
Intravenous
Life Sciences & Biomedicine
Cohort study
Human
medicine.medical_specialty
BATS Consortium
Adolescent
Immunoglobulins
610 Medicine & health
Regression Analysi
Antibodies
Immunomodulation
03 medical and health sciences
Medicine, General & Internal
Pharmacotherapy
Drug Therapy
Clinical Research
Internal medicine
General & Internal Medicine
medicine
MANAGEMENT
Confidence Intervals
Humans
Preschool
Propensity Score
Glucocorticoids
Mechanical ventilation
Science & Technology
business.industry
SARS-CoV-2
Inflammatory and immune system
COVID-19
Odds ratio
medicine.disease
Respiration, Artificial
Confidence interval
KAWASAKI-LIKE DISEASE
COVID-19 Drug Treatment
Systemic inflammatory response syndrome
10036 Medical Clinic
Immunoglobulins, Intravenou
Propensity score matching
Cohort Studie
business
ACUTE RESPIRATORY SYNDROME
Confidence Interval
TOXIC-SHOCK-SYNDROME
Subjects
Details
- Language :
- English
- ISSN :
- 15334406 and 00284793
- Database :
- OpenAIRE
- Journal :
- The New England Journal of Medicine
- Accession number :
- edsair.doi.dedup.....9e1881eae8516a8fe7180dba6ff0ab3a