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Sugunan S, Bindusha S, Niyas HR, Geetha S, Chinchilu RV. Factors Associated with Pulse Methylprednisolone Treatment Failure in COVID-19-Related Multisystem Inflammatory Syndrome in Children (MIS-C). J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1755210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
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.
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Affiliation(s)
- Sheeja Sugunan
- Department of Paediatrics, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - S. Bindusha
- SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
| | - H. R. Niyas
- SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
| | - S. Geetha
- SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
| | - R V Chinchilu
- SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India
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