Department of Pediatric Critical Care Medicine, Hacettepe University, Ankara, Turkey.
Life Support Practice and Research Center, Hacettepe University, Ankara, Turkey.
J Clin Apher. 2022 Jun;37(3):281-291. doi: 10.1002/jca.21971. Epub 2022 Feb 17.
Multisystem inflammatory syndrome in children (MIS-C) can be life threatening in severe cases because of uncontrolled inflammation and multi-organ failure. In this study, we report the effect of plasma exchange in the treatment of MIS-C and to emphasize the effect of its early application on outcome.
In this retrospective observational study, the medical records of children with severe MIS-C admitted to pediatric intensive care unit (PICU) between April 2020 and January 2021 were reviewed. Severe MIS-C patients were treated according to protocol consisting of plasma exchange (PE), intravenous immune globulin, steroids, and anakinra which we called the "PISA" protocol referring to the initials. The patients were divided into two groups as early plasma exchange (E-PE) and late plasma exchange (L-PE) according to the elapse time between hospital admission and the administration of PE. Groups were compared in terms of outcome variables. Primary study outcome was 28-day mortality. Secondary outcome variables were acute phase response time, length of immunomodulatory treatment, frequency of patients requiring mechanical ventilation (MV) and inotropic support, length of inotropic support and MV, length of hospital and PICU stays.
Eighteen pediatric patients with MIS-C were included in the study. Seventeen (95%) of the patients presented with decompensated shock and required inotropic support. One of the 17 patients needed extracorporeal membrane oxygenation support (ECMO) PISA protocol was used in all patients. There was no mortality in the E-PE group while the mortality rate was 20% in the L-PE group. Acute phase reactant response was faster in the E-PE group and immunomodulatory treatments could be reduced earlier; the frequency of patients requiring inotropic and mechanical ventilation (MV) support was lower in the E-PE group; the duration of inotropic support, duration of MV, and length of stay in hospital and PICU were significantly shorter in the E-PE group.
We suggest that in selected cases, timely administration of PE is a beneficial rescue therapy for MIS-C related hyperinflammation presenting with severe cardiovascular collapse.
儿童多系统炎症综合征（MIS-C）可因失控性炎症和多器官衰竭而在严重病例中危及生命。在本研究中，我们报告了血浆置换治疗 MIS-C 的效果，并强调了其早期应用对结局的影响。
在这项回顾性观察性研究中，回顾了 2020 年 4 月至 2021 年 1 月期间入住儿科重症监护病房（PICU）的重症 MIS-C 患儿的病历。根据包括血浆置换（PE）、静脉注射免疫球蛋白、类固醇和 anakinra 的方案治疗重症 MIS-C 患儿，我们将该方案称为“PISA”方案，这是方案缩写。根据从入院到行 PE 之间的时间间隔，患者分为早期血浆置换（E-PE）和晚期血浆置换（L-PE）两组。比较两组的结局变量。主要研究结局为 28 天死亡率。次要结局变量为急性期反应时间、免疫调节治疗时间、需要机械通气（MV）和正性肌力支持的患者频率、正性肌力支持和 MV 时间、住院时间和 PICU 住院时间。
18 例 MIS-C 患儿纳入研究。17 例（95%）患儿表现为失代偿性休克，需要正性肌力支持。17 例患儿中有 1 例需要体外膜氧合支持（ECMO），所有患儿均采用 PISA 方案。E-PE 组无死亡，L-PE 组死亡率为 20%。E-PE 组急性期反应物反应更快，免疫调节治疗可更早开始减少；E-PE 组需要正性肌力和机械通气（MV）支持的患者频率较低；E-PE 组正性肌力支持时间、MV 时间、住院时间和 PICU 住院时间明显缩短。
我们建议，在选择的病例中，及时给予 PE 是一种有益的抢救疗法，可用于治疗伴有严重心血管衰竭的 MIS-C 相关过度炎症。
