key: cord-0707807-c10ryde0
authors: Belhadjer, Zahra; Auriau, Johanne; Méot, Mathilde; Oualha, Mehdi; Renolleau, Sylvain; Houyel, Lucile; Bonnet, Damien
title: Addition of Corticosteroids to Immunoglobulins Is Associated With Recovery of Cardiac Function in Multi-Inflammatory Syndrome in Children
date: 2020-10-28
journal: Circulation
DOI: 10.1161/circulationaha.120.050147
sha: 71c586dd33c5989d522b7cc56db0a62a850dd60a
doc_id: 707807
cord_uid: c10ryde0

nan

Circulation. 2020;142:2282-2284. DOI: 10.1161/CIRCULATIONAHA.120.050147

December 8, 2020 2283 CORRESPONDENCE stay in the group receiving a combination of IVIG and steroids in comparison with the group receiving only IVIG, respectively, 2.9 versus 5.4 days, 6.4 versus 20.6 days, and 3.4 versus 5.3 days (P<0.05) (Figure) . Left main coronary artery z score was 0 (IQR, -0.7 to 0.6) at baseline and -0.5 (IQR, -1.3 to 0) at discharge without significant differences between the groups.

Acute left ventricular systolic and diastolic dysfunction are prominent findings in MIS-C. All recent reports show that B-type natriuretic peptide or N-terminal pro B-type natriuretic peptide levels are very high, whereas troponin elevation is usually mild to moderate. 1, 3 Together with the rapid recovery of cardiac function, these findings are in favor of myocardial stunning rather than myocarditis in MIS-C. A recent cardiac magnetic resonance study in patients with MIS-C reported evidence of myocardial edema with no late gadolinium enhancement that would be suggestive of necrosis. 4 Patients with MIS-C appear to be responsive to IVIG. 1,3 Still, there is no direct evidence that IVIG improves outcomes in MIS-C 2 or that an adjunct of other anti-inflammatory agents is effective. To resolve the severe inflammatory state associated with MIS-C, some children have been successfully treated with steroids, anakinra, an interleukin-1 receptor antagonist, or with infliximab. 1, 3 During the second period of our series, we added steroids to target systemic inflammation and reduce cytokine storm. Recent data suggest some benefit of corticosteroid therapy in the treatment of inflammatory lung complications of coronavirus disease 2019 (COVID-19) , and corticosteroids could play a similar role in other later inflammatory complications of SARS-CoV-2 infection such as MIS-C. 5 The major limitation of our study is the absence of randomization, but it was not possible to set up this type of trial in the context of a severe emerging syndrome. Increasing awareness on MIS-C and more standardized management could have influenced outcomes, but the day of admission and cardiac parameters were similar in the 2 study groups.

This observational study suggests that adding corticosteroids to immunoglobulins is associated with a shorter time to recovery of cardiac function in patients with MIS-C. Further evaluation in randomized controlled trials is needed to confirm these findings and to define the optimal treatment strategy in MIS-C.

Data are available on request. 

Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic

American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association

Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2

Cardiac MRI of children with multisystem inflammatory syndrome (MIS-C) associated with COVID-19: case series

Dexamethasone in hospitalized patients with Covid-19-preliminary report