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Article Type

Original Study

Abstract

Objectives To compare the outcomes of multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 infection treated with intravenous immunoglobulin (IVIG) and without IVIG. Patients and methods A retrospective observational study was conducted over a period of 2 months. We enrolled all children (1–18 years, both sexes) who presented with coronavirus disease 2019-associated MIS-C (as per WHO definition). The patient classification and treatment were done as per the PGIMER Chandigarh protocol (IVIG along with corticosteroids and aspirin was given in all cases with moderate, severe disease, and Kawasaki disease phenotype). Mild cases did not receive IVIG but received corticosteroids and aspirin. Respiratory support was given in cases with breathing difficulty. The primary outcomes of the children were noted in terms of ICU stay, requirement of ventilation, requirement of High flow nasal cannula (HFNC), and nasal oxygen. Response with respect to inflammatory parameters and coronary diameters were also assessed as secondary outcomes. Results Among 52 patients enrolled in the study, 25 had mild, 17 had moderate, eight had severe disease, and two had Kawasaki disease phenotype. Among 27 cases requiring IVIG, seven cases did not receive IVIG. In children who received IVIG (n = 20), there were higher odds of ICU stay [odds ratio (OR) 1.185], ventilation (OR 8.784), need for CPAP (OR 5), and HFNC (OR 3.75) but all of these were statistically insignificant (P > 0.05). Among the inflammatory markers, there was a significant reduction in the C-reactive protein levels (23.3 vs. 5, P = 0.004, OR 1.028) with the use of IVIG. There was no significant difference in the change in the D-dimer levels (1480 vs. 449.38, P = 0.148) and coronary artery diameter after the treatment. Conclusion The changing evidence about the use of IVIG producing similar outcomes to those not using IVIG suggests that corticosteroids and aspirin can alone be used in cases of MIS-C irrespective of the severity of the disease. However, considering the significant reduction in the inflammatory marker (C-reactive protein) after the use of IVIG in moderate to severe cases, its administration may not totally be negated.

Keywords

Coronavirus disease 2019, intravenous immunoglobulin, multisystem inflammatory syndrome in children

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