For a study, researchers sought to investigate the current use, results, and side effects of biological agents in the treatment of severe multisystem inflammatory syndrome in children (MIS-C) in patients who are followed up in a pediatric critical care unit (PICU). The observational, descriptive, medical records review research was conducted on patients admitted to the PICU with MIS-C between September 1 and November 1, 2020. They established that patients were positive for present or recent SARS-CoV-2 infection or COVID-19 exposure history during the 4 weeks preceding the beginning of symptoms by reviewing medical records.
A total of 33 patients with severe MIS-C (21 male) with a median age of 9 were included in the study. During the course of the disease, the most prevalent signs and symptoms were fever (100%) and stomach discomfort (75.5% ). 63.6% of patients had clinical characteristics associated with Kawasaki disease/Kawasaki disease shock syndrome, whereas 36.4% had secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. During the PICU stay, 18 patients had myocardial dysfunction and/or coronary artery anomalies. 33 patients received intravenous immunoglobulin and corticosteroids. Anakinra was given to 23 patients (69.6% ). At the conclusion of the first week of treatment, there was a substantial rise in lymphocyte and platelet counts and a significant drop in ferritin, B-type natriuretic peptide, and troponin levels in patients who received biological therapy. Due to an inadequate response to anakinra, 2 patients were transferred to tocilizumab. The PICU mortality rate for MIS-C patients was 6.0%.
Management of systemic inflammation and shock is critical in MIS-C to reduce mortality and the development of chronic heart dysfunction. In patients with significant symptoms and heart dysfunction, an intensive therapeutic strategy, including biological medicines, may be necessary.