Treatment of Multisystem Inflammatory Syndrome in Children: Understanding Differences in Results of Comparative Effectiveness Studies.
Treatment of Multisystem Inflammatory Syndrome in Children: Understanding Differences in Results of Comparative Effectiveness Studies.
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DOI：
10.1002/acr2.11478
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发表时间：
2022-09
影响因子：
3.4
通讯作者：
Son, Mary Beth F
中科院分区：
文献类型：
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作者：
Melgar, Michael;Seaby, Eleanor G;McArdle, Andrew J;Young, Cameron C;Campbell, Angela P;Murray, Nancy L;Patel, Manish M;Levin, Michael;Randolph, Adrienne G;Son, Mary Beth F
在儿童多系统炎性综合征（MIS-C）患者中进行的两项队列研究显示，与IVIG和糖皮质激素相比，单独静脉注射免疫球蛋白（IVIG）进行初始免疫调节治疗的获益具有对比性结果。我们试图确定是否应用不同的MIS-C定义和不同的疾病严重程度之间的队列不一致的结果。克服COVID-19公共卫生监测登记研究（OC-19）包括符合美国疾病控制和预防中心（CDC）MIS-C定义的患者，而最佳治疗研究（BATS）应用了世界卫生组织（WHO）的定义。我们将WHO定义应用于OC-19队列，将CDC定义应用于BATS队列，并确定不符合替代定义的比例。我们比较了队列之间的疾病严重程度指标。在349例OC-19患者中，9.5%不符合WHO定义。在350例BATS患者中，10.3%不符合CDC定义。两个队列之间的大多数器官系统受累相似，但OC-19患者中WHO定义的心脏受累更多（87.1% vs 79.4%，P = 0.008）。OC-19患者更常入院接受重症监护（61.0% vs 44.8%，P < 0.001），并且在免疫调节治疗前更常接受血管加压药或正性肌力药（39.5% vs 22.9%，P < 0.001）。与BATS队列相比，OC-19队列的疾病严重程度和心血管受累程度更高，并且未使用不同的MIS-C病例定义，可能导致关于MIS-C最佳初始治疗的研究结论不同。在未来的MIS-C研究设计和治疗建议中应考虑疾病的严重程度，以确定可从积极免疫调节治疗中获益的患者。
Two cohort studies in patients with multisystem inflammatory syndrome in children (MIS‐C) demonstrated contrasting results regarding the benefit of initial immunomodulatory treatment with intravenous immunoglobulin (IVIG) alone versus IVIG and glucocorticoids. We sought to determine whether application of different MIS‐C definitions and differing disease severity between cohorts underlay discrepant results. The Overcoming COVID‐19 Public Health Surveillance Registry (OC‐19) included patients meeting the US Centers for Disease Control and Prevention (CDC) MIS‐C definition, whereas the Best Available Treatment Study (BATS) applied the World Health Organization (WHO) definition. We applied the WHO definition to the OC‐19 cohort and the CDC definition to the BATS cohort and determined the proportion that did not meet the alternate definition. We compared illness severity indicators between cohorts. Of 349 OC‐19 patients, 9.5% did not meet the WHO definition. Of 350 BATS patients, 10.3% did not meet the CDC definition. Most organ system involvement was similar between the cohorts, but more OC‐19 patients had WHO‐defined cardiac involvement (87.1% vs 79.4%, P = 0.008). OC‐19 patients were more often admitted to intensive care (61.0% vs 44.8%, P < 0.001) and more often received vasopressors or inotropes (39.5% vs 22.9%, P < 0.001) before immunomodulatory treatment. Greater illness severity and cardiovascular involvement in the OC‐19 cohort compared with the BATS cohort, and not use of different MIS‐C case definitions, may have contributed to differing study conclusions about optimal initial treatment for MIS‐C. Disease severity should be considered in future MIS‐C study designs and treatment recommendations to identify patients who would benefit from aggressive immunomodulatory treatment.