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.

The study was approved by the institutional ethical committee. Information form validated by the ethics committee was provided to all participants. Informed written consent was obtained from all study participants. The study is an interim analysis of an ongoing study in the department.

S.S. conceptualized the study and drafted the manuscript. B.S. conducted statistical analysis and revision of the manuscript for intellectual content. N.H.R. performed data acquisition and drafting of the manuscript. G.S. conducted statistical analysis and critical revision of the manuscript. C.R.V. contributed to the revision of the manuscript for intellectual content. All authors approved the version for final publication.

Received: 22 March 2022

Accepted: 31 May 2022

Article published online:
13 September 2022

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