A retrospective comparative analysis of factors affecting the decision and outcome of initial intravenous immunoglobulin alone or intravenous immunoglobulin plus methylprednisolone use in children with the multisystem inflammatory syndrome

Patients and settings

This retrospective cohort study was carried out at the Dr. Behçet Uz Children’s Hospital of the Health Sciences Faculty of Medicine between April 1, 2020, and November 1, 2021. In Turkey’s Aegean Region, the hospital serves as a pediatric patients’ referral facility. The study included all children identified as having MIS-C in accordance with CDC guidelines [9]. The criteria for a conclusive diagnosis included epidemiological association to COVID-19 in addition to prolonged fever, elevated inflammatory biomarkers, indications of multi-organ involvement, and the exclusion of any other diagnosis [9]. Through nasopharyngeal real-time reverse transcription polymerase chain reaction analysis and/or SARS-CoV-2 antibody testing, all patients had to demonstrate that they had been exposed to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Four weeks prior to the development of clinical symptoms, exposure to a suspected or confirmed COVID-19 case was also noted. Several molecular and microbiological diagnostic tests, such as multiplex PCR tests for common respiratory pathogens, rapid antigen tests for influenza, serological tests for the Epstein-Barr virus, conventional culture tests, such as blood and throat cultures in addition to peripheral smears, ultrasonography, etc., were used to rule out other diagnoses.

According to the measurements of infrared thermometers, fever was defined as a temperature of 38 °C or higher [22]. The patients who had fever after the end of IVIG were noted and the time of re-occurrence of fever after the end of the IVIG therapy was recorded. Through the use of the electronic medical record system and patient files, demographic information, symptoms, medical history, and distinguishing characteristics of the patients were gathered.

According to whether they received IVIG alone or IVIG with methylprednisolone as an initial treatment for MIS-C, the patients were split into two groups. The IVIG dosage for the patients in group I was 2 gr/kg, whereas the IVIG dosage for the patients in group II was 2 gr/kg + 2 mg/kg/day of methylprednisolone.

SPSS Statistical Software was used to conduct the statistical analysis (version 22; SPSS, Chicago, IL, USA). We compared categorical variables using Fisher’s exact and Pearson’s 2 tests. The Mann–Whitney U test or the t test were used to compare numerical variables (depending on whether they show normal distribution or not). Categorical variables were given as frequencies and percentages, whereas continuous variables were shown as means and standard deviation.

The Institutional Review Board of the Dr. Behcet Uz Children’s Training and Research Hospital gave ethics approval for this study.

Definitions and treatments

According to the measurements of infrared thermometers, fever was defined as a temperature of 38 °C or higher [22]. The patients who had fever after the end of IVIG were noted and the time of re-occurrence of fever after the end of the IVIG therapy was recorded. Through the use of the electronic medical record system and patient files, demographic information, symptoms, medical history, and distinguishing characteristics of the patients were gathered.

According to whether they received IVIG alone or IVIG with methylprednisolone as an initial treatment for MIS-C, the patients were split into two groups. The IVIG dosage for the patients in group I was 2 gr/kg, whereas the IVIG dosage for the patients in group II was 2 gr/kg + 2 mg/kg/day of methylprednisolone.

Statistics

SPSS Statistical Software was used to conduct the statistical analysis (version 22; SPSS, Chicago, IL, USA). We compared categorical variables using Fisher’s exact and Pearson’s 2 tests. The Mann–Whitney U test or the t test were used to compare numerical variables (depending on whether they show normal distribution or not). Categorical variables were given as frequencies and percentages, whereas continuous variables were shown as means and standard deviation.

The Institutional Review Board of the Dr. Behcet Uz Children’s Training and Research Hospital gave ethics approval for this study.

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