Division of Infectious diseases, Department of Pediatric Infectious Diseases, Sainte Justine University Hospital, University of Montreal, Quebec, Canada.
Infection, Antimicrobials, Modelling, Evolution, Inserm, UMR 1137, Paris University, Paris, France.
Pediatrics. 2023 Jul 1;152(1). doi: 10.1542/peds.2022-061173.
Studies comparing initial therapy for multisystem inflammatory syndrome in children (MIS-C) provided conflicting results.
To compare outcomes in MIS-C patients treated with intravenous immunoglobulin (IVIG), glucocorticoids, or the combination thereof.
Medline, Embase, CENTRAL and WOS, from January 2020 to February 2022.
Randomized or observational comparative studies including MIS-C patients <21 years.
Two reviewers independently selected studies and obtained individual participant data. The main outcome was cardiovascular dysfunction (CD), defined as left ventricular ejection fraction < 55% or vasopressor requirement ≥ day 2 of initial therapy, analyzed with a propensity score-matched analysis.
Of 2635 studies identified, 3 nonrandomized cohorts were included. The meta-analysis included 958 children. IVIG plus glucocorticoids group as compared with IVIG alone had improved CD (odds ratio [OR] 0.62 [0.42-0.91]). Glucocorticoids alone group as compared with IVIG alone did not have improved CD (OR 0.57 [0.31-1.05]). Glucocorticoids alone group as compared with IVIG plus glucocorticoids did not have improved CD (OR 0.67 [0.24-1.86]). Secondary analyses found better outcomes associated with IVIG plus glucocorticoids compared with glucocorticoids alone (fever ≥ day 2, need for secondary therapies) and better outcomes associated with glucocorticoids alone compared with IVIG alone (left ventricular ejection fraction < 55% ≥ day 2).
Nonrandomized nature of included studies.
In a meta-analysis of MIS-C patients, IVIG plus glucocorticoids was associated with improved CD compared with IVIG alone. Glucocorticoids alone was not associated with improved CD compared with IVIG alone or IVIG plus glucocorticoids.
比较儿童多系统炎症综合征（MIS-C）初始治疗的研究结果相互矛盾。
比较静脉注射免疫球蛋白（IVIG）、糖皮质激素或两者联合治疗 MIS-C 患者的结局。
2020 年 1 月至 2022 年 2 月期间的 Medline、Embase、CENTRAL 和 WOS。
包括<21 岁 MIS-C 患者的随机或观察性比较研究。
两名评审员独立选择研究并获取个体参与者数据。主要结局为心血管功能障碍（CD），定义为左心室射血分数<55%或初始治疗第 2 天需要使用血管加压药，采用倾向评分匹配分析进行分析。
在确定的 2635 项研究中，有 3 项非随机队列研究被纳入。meta 分析共纳入 958 名儿童。与 IVIG 单药治疗相比，IVIG 联合糖皮质激素治疗组 CD 改善（比值比[OR]0.62[0.42-0.91]）。与 IVIG 单药治疗相比，糖皮质激素单药治疗组 CD 未改善（OR 0.57[0.31-1.05]）。与 IVIG 联合糖皮质激素治疗相比，糖皮质激素单药治疗组 CD 未改善（OR 0.67[0.24-1.86]）。二次分析发现，与 IVIG 联合糖皮质激素治疗相比，IVIG 联合糖皮质激素治疗与更好的结局相关（发热持续至第 2 天、需要辅助治疗），与 IVIG 单药治疗相比，糖皮质激素单药治疗与更好的结局相关（左心室射血分数<55%持续至第 2 天）。
纳入研究的非随机性质。
在 MIS-C 患者的 meta 分析中，与 IVIG 单药治疗相比，IVIG 联合糖皮质激素治疗与 CD 改善相关。与 IVIG 单药治疗或 IVIG 联合糖皮质激素治疗相比，糖皮质激素单药治疗与 CD 改善无关。
