In-hospital and post-discharge outcomes of pediatric acute myocarditis underwent after high-dose steroid or intravenous immunoglobulin therapy

Lin, Ming‐Shyan; Tseng, Yu-Hsiang; Chen, Mei‐Yen; Chung, Chang-Min; Tsai, Ming-Horng; Wang, Po‐Chang; Chang, Jung-Jung; Chen, Tien-Hsing; Lin, Yu‐Sheng

doi:10.1186/s12872-018-0981-3

Cited by 22 publications

(22 citation statements)

References 36 publications

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“…However, the study in the pediatric population had limitations of lack of a matched control group and the fact that myocarditis patients already had high survival rates. A recent study evaluated 1542 pediatric patients who were hospitalized for acute myocarditis . They were divided into three groups: Those receiving neither steroid nor IVIG; those receiving high‐dose steroid alone; and those receiving IVIG alone.…”

Section: Follow‐up and Restrictionsmentioning

confidence: 99%

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Myocarditis in the pediatric population: A review

Dasgupta

Iannucci

Mao

et al. 2019

Congenital Heart Disease

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Myocarditis has a variable clinical presentation and there is still debate regarding accurate diagnostic criteria. Adding to the controversy surrounding this diagnosis, there is no clear consensus for the treatment or ongoing follow‐up of patients with myocarditis. All of this makes the diagnosis and management of myocarditis a particular challenge in the pediatric population. Furthermore, the literature with respect to this topic is dynamic and ever‐changing. In this review article, we aim to review and summarize the common clinical presentations of myocarditis, along with the latest recommendations for diagnostic criteria, treatment, and follow‐up of patients with myocarditis.

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Section: Follow‐up and Restrictionsmentioning

confidence: 99%

“…A recent study evaluated 1542 pediatric patients who were hospitalized for acute myocarditis. 83 They were divided into three groups: Those receiving neither steroid nor IVIG; those receiving high-dose steroid alone; and those receiving IVIG alone.…”

Section: Statement For Eligibility and Disqualification Recommendationsmentioning

confidence: 99%

Myocarditis in the pediatric population: A review

Dasgupta

Iannucci

Mao

et al. 2019

Congenital Heart Disease

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“… 7 Although contemporaneous studies showed clinical and immunophenotypic differences between Kawasaki’s disease and MIS-C, 8-10 findings of myocarditis in many patients with MIS-C also supported treatment with IVIG, given its use in clinical practice for viral myocarditis. 11 , 12 Features of cytokine storm led to the use of dexamethasone in patients with acute Covid-19, 13 and the frequent concurrent finding of a severe shock-like presentation in patients with MIS-C 14 probably encouraged the use of glucocorticoids, in varying doses. 15 …”

mentioning

confidence: 99%

Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes

et al. 2021

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Background The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy. Methods We analyzed surveillance data on inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 U.S. hospitals between March 15 and October 31, 2020. The effectiveness of initial immunomodulatory therapy (day 0, indicating the first day any such therapy for MIS-C was given) with intravenous immune globulin (IVIG) plus glucocorticoids, as compared with IVIG alone, was evaluated with propensity-score matching and inverse probability weighting, with adjustment for baseline MIS-C severity and demographic characteristics. The primary outcome was cardiovascular dysfunction (a composite of left ventricular dysfunction or shock resulting in the use of vasopressors) on or after day 2. Secondary outcomes included the components of the primary outcome, the receipt of adjunctive treatment (glucocorticoids in patients not already receiving glucocorticoids on day 0, a biologic, or a second dose of IVIG) on or after day 1, and persistent or recurrent fever on or after day 2. Results A total of 518 patients with MIS-C (median age, 8.7 years) received at least one immunomodulatory therapy; 75% had been previously healthy, and 9 died. In the propensity-score–matched analysis, initial treatment with IVIG plus glucocorticoids (103 patients) was associated with a lower risk of cardiovascular dysfunction on or after day 2 than IVIG alone (103 patients) (17% vs. 31%; risk ratio, 0.56; 95% confidence interval [CI], 0.34 to 0.94). The risks of the components of the composite outcome were also lower among those who received IVIG plus glucocorticoids: left ventricular dysfunction occurred in 8% and 17% of the patients, respectively (risk ratio, 0.46; 95% CI, 0.19 to 1.15), and shock resulting in vasopressor use in 13% and 24% (risk ratio, 0.54; 95% CI, 0.29 to 1.00). The use of adjunctive therapy was lower among patients who received IVIG plus glucocorticoids than among those who received IVIG alone (34% vs. 70%; risk ratio, 0.49; 95% CI, 0.36 to 0.65), but the risk of fever was unaffected (31% and 40%, respectively; risk ratio, 0.78; 95% CI, 0.53 to 1.13). The inverse-probability-weighted analysis confirmed the results of the propensity-score–matched analysis. Conclusions Among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. (Funded by the Centers for Disease Control and Prevention.)

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“…In total, the summary covers 1,891 children diagnosed with myocarditis (Table 1) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. It is, therefore, a rare disease.…”

Section: Resultsmentioning

confidence: 99%