Citations 4
PP398 [Infections » Covid-19 / Sars-CoV-2]: EARLY COMBINATION THERAPY WITH IMMUNOGLOBULIN AND STEROIDS IS ASSOCIATED WITH SHORTER ICU LENGTH OF STAY IN MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN ASSOCIATED WITH COVID19
Harthan, Aaron A. , Nadiger, Meghana , McGarvey, Jeremy , Hanson, Keith , Chiotos, Katie, Miller, Aaron S., Reikoff, Ronald A., Kumar, Vishakha K. , Gharpure, Varsha , Bjornstad, Erica C. , Gajic, Ognjen , Walkey, Allan J. , Kashyap, Rahul , Tripathi, Sandeep
Pediatric Critical Care Medicine | November 3, 2022 | Volume: 23 | Issue: Supplement 1 11S | Pages: No page available
Association of Early Steroid Administration With Outcomes of Children Hospitalized for COVID-19 Without Multisystem Inflammatory Syndrome in Children
Nadiger, Meghana , McGarvey, Jeremy , Harthan, Aaron A. , Lombardo, Mónica, Perkins, Nicholas , Sayed, Imran A., Bhalala, Utpal , Raju, Umamaheswara, Miller, Aaron S., Boman, Karen , Arteaga, Grace M. , Bansal, Vikas , Tekin, Aysun , Kumar, Vishakha K. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Kovačević, Tanja , Markić, Joško , Ardalic, Tatjana Capitovic , Polić, Branka , Ivić, Ivo, Carev, Dominko , Glavinić, Robert, Vadgaonkar, Girish, Ediga, Rekha, Basety, Shilpa, Dammareddy, Shwetha, Kasumalla, Phani Sreeharsha, Manduva, Janaki, Kolakani, Naresh, Sripathi, Shreeja , Chaitanya, Sheetal, Papani, Sridhar, Kamuram, Mahesh, Mohan, Surapaneni Krishna, Jyothisree, Ekambaram, Petrolwala, Mukur, Ladva, Bharat, Kodate, Akira, Suzuki, Reina , Moriki, Koyo, Hassan-Hanga, Fatimah , Gezawa, Abubakar Shehu, Kabara, Halima M. S., Amole, Taiwo Gboluwaga , Kabir, Halima , Haliru, Dalha Gwarzo, Ibrahim, Abdullahi S., Asghar, Muhammad Sohaib , Syed, Mashaal , Naqvi, Syed Anosh Ali, Yasmin, Farah , Ahmed, Iftekhar , Ishaque, Sidra , Saleem, Ali Faisal , Alarifi, Mohammed I, Macarambon, Jara Mia, Bukhari, Ahmad Abdullah, Albahrani, Hussain A., Aldossary, Kaltham M., Malki, Walid, Kouzoukas, Brenna, Jacobs, Nekaiya, Ganbote, Tejashree, Valentine, Beryl, Sreerama, Pavan, Havalad, Vinod, Barry, Suzanne, Woll, Christopher , Wu, Gregory F. , Carrole, Erin, Burke, Kathryn , Irby, Katherine , Sanders, Ronald C., Hefley, Glenda, Christie, Amy B. , Adiga, Rajani, Campbell, Beth Salvagio , Wilson, Cathleen, Rivers, Patrick , Brinks, Jonathan, Mongoh, Mokenge Ndiva, Gilson, Boris, Danesh, Valerie , Dubrocq, Gueorgui , Davis, Amber, Hammers, Marissa J, McGahey, Ill M, Farris, Amanda C., Priest, Elisa L. , Korsmo, Robyn, Fares, Lorie, Skiles, Kathy, Shor, Susan M, Burns, Kenya, Dowell, Corrie A., Gonzales, Gabriela “ Hope”, Flores, Melody, Newman, Lindsay, Wilk, Debora A., Ettlinger, Jason, Bomar, Jaccallene, Darji, Himani, Arroliga, Alejandro C. , Khandhar, Paras B., Kring, Elizabeth, Anderson, Edwin L., Nagy, Rosemary, Inja, Ravali R., Nawathe, Pooja , Tsing, Jennifer, Carr, Karen, Chaudhary, Anila , Guglielmino, Kathleen, Strom, Larisa, Chiotos, Kathleen, Lee, Giyoung , Burnett, Ryan H., Sydney, Guy I. , Traynor, Danielle M., Ahmed, Farzin, Deonarine, Christopher, Jones, Ashley, Shaikh, Mohammad-Ali , Preston, David A. , Chin, Jeanette, Milligan, Patrick S., Koglin, Joy M., Gibson, Regina, Johnson, Lana, Preston, Felicia, Scott, Crimson, Nungester, Bethany, Menter, Sarah, Wasilewski, A., Kaul, Viren , Austin, Praise, Rogner, Jaimie, Russo, Anthony J. , Ontai, Sidney , Contreras, Brian, Obinwanko, Uzoma, Amamasi, Nneka, Sharafi, Amir, Kaufman, Margit, Lobel, G, Gandhi, Nisha, AbdelAty, Amr M. , Shaji, Elizabeth, Lim, Kiana, Marte, Juan M., Sosa, Dani Ashley, Roth, Prerana , Litwin, Alain H. , Pariyadath, Anand, Moschella, Phillip , Llano, Trayson, Salas, Alan, Daube, Ariel , Korn, Michelle, Rajagopalan, Logi, Santos, Laura Jurema dos , Crandall, Christine , Stojanovski, Sasko, Michienzi, Kelly, Amer, Marwa , Dahhan, Talal, Kseibi, Eiad, Butt, Abid, Khurshid, Syed Moazzum, Rabee, Muath, Abujazar, Mohammed, Alghunaim, Razan, Abualkhair, Maal, AlFirm, Abeer Turki, Oulds, Franscene, Nandavar, Akshay, Wen, Andy , DaCar, Allie, Reilkoff, Ronald A., Eichen, Sarah, Goertzen, Lexie, Rajala, Scott, Feussom, Ghislaine, Domecq, Juan Pablo , Sharma, Mayank , Qamar, Shahraz , Morales, Diana J. Valencia , Khan, Syed Anjum , Jain, Nitesh , Wang, Christine, Kotekal, Dhatri, Sendi, Prithvi , Aulakh, Bhagat , Bandy, Jennifer A., Kreps, Lisa M., Bollinger, Dawn R., Nadiger, Meghana, Schauf, Victoria, Rich, Deana, Anderson, Harry L., Rajkumar, Dixy, Abunayla, Ali, Heiter, Jerrilyn, Zaren, Howard A. , Smith, Stephanie J., Lewis, Grant C., Seames, Lauren, Farlow, Cheryl, Miller, Judy, Broadstreet, Gloria, Terrill, Cindy, Montgomery, Brock, Reyes, Sydney A, Reyes, Summer M, Plattner, Alex, Martinez, Anthony , Allison, Micheal, Mittal, Aniket, Ruíz, Rafael Azuar , Skaanland, Aleta, Amzuta, Ioana, Shah, Amish , Modi, Ritu, Al-Khalisy, Hassan, Masuta, Pardeep , Schafer, Melissa , Wratney, Angela, Jones, Tracy L., Ayers, Shonda C., Harrell, Amy B., Brown, Brent R., Malone, Kassidy, Sinko, Lauren A, Hrarrell, Amy B, Settle, Lisa, Sears, Taylor J., Kuehne, Joshua, Garcia, Melinda, Beebe, Morgan, Herrera, Heather , Belden, Katherine A. , Baram, Michael , Weber, Devin , DePaola, Rosalie, Xia, Yuwei , Carter, Hudson, Tolley, A. E., Ferranti, Mary, House, Scott, Aldana, Isabella, Stulce, Casey , Chong, Grace , Ghavam, Ahmeneh , Baslanti, Tezcan Ozrazgat, Omalay, George, Hashemighouchani, Haleh , Cupka, Julie S , Hubbard, Janice, Nazir, Usman, Rampon, Garrett , Riggle, Jake, Dismang, Nathan, Sullivan, Janice, Morris, Sarah, Nason, Jennifer, Rahman, Rania Abdul, Mulrow, Mary, Gál, Tamás, Mahashabde, Manasi, Vagonis, Alexandra , Uber, Rebecca, Mahmud, Haseeb , Leightle, Stefan, Zhang, Zoe, Vissichelli, Nicole C. , O'Meara, A M Iqbal, Rocawich, Katie, Harris, Lynnette , Cusson, Bruce, Reeves, Brandon, Fanelli, Jessica, Disher, Nataya, Samant, Anusha, DeGroot, Chritian, Youshock, Evan, Ligon, R. Miller, McCartney, Katherine, Garcia, Julio, Iloabachie, Chidi, Flores, Kelsey, VanEenenaam, David P., Sands, Lauren , Sweatt, Nia, Fowler, Jacob , Fram, Madeline, Howard, Easton, Johnson, Kathleen N. , Udoh, Imoh, Nosow, Lillian, Howard, Lucy Winesett, Pham, Quan Duc Minh, Irfanullah, Aman, Ong, Tiffany, Enwezor, Chukwunyelu Henry, Dabagian, Hannah, Bansal, Vikas , Asghar, Muhammad S , Tekin, Aysun , Tripathi, Sandeep , Lombardo, Monica, Gharpure, Varsha , Chiotos, Kathleen , Bjornstad, Erica C. , Dapul, Heda , Montgomery, Vicki , Deo, Neha , Gajic, Ognjen , Kashyap, Rahul , Walkey, Allan J. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Itagaki, Yuki , Galadanci, Hadiza , Kabara, Halima Salisu, Syed, Mashaal, Almazyad, Mohammed , Asfina, Kazi Nur , Cooper, Paul R. , Burke, Kathryn, Mohammed, Mustafa, Ashley, Dennis W. , Mosier, Jarrod , Lutrick, Karen , Dubrocq, Gueorgui , Nagy, Rosemary, Inja, Ravali R., Pedraza, Isabel , Carr, Karen, Gist, Katja M. , Chiotos, Kathleen, Blatz, Allison M. , Cheruku, Sreekanth , Preston, David, Gupta, Sandeep , Abdelaty, Amr, Rennert, Lior , Ramírez, Michelle , Verma, Sourabh , Stojanovski, Sasko D., Johnson, Kristin, Bawazeer, Mohammed Abdullah , Gupta, Manoj , Heneghan, Julia A. , Tang, Ben, Lal, Amos , O’Horo, John C. , Singh, Romil , Koritala, Thoyaja , Tarabichi, Yasir , Perzynski, Adam T. , Wang, Christine, Totapally, Balagangadhar , Nadiger, Meghana, Wall, Chris, Menon, Shina , McGuire, John K. , Anderson, Harry L., Miller, Judy, Lin, John C. H. , Montgomery, Brock, Ruiz, Rafael, Ross, Robert, Gupta, Neha , Brown, Brent , Tolley, Aaron, Tofil, Nancy M. , Mayampurath, Anoop , Bihorac, Azra , Ruppert, Matthew M. , McGonagill, Patrick W. , Galet, Colette , Wang, David , Allan, Lauren , Badheka, Aditya V. , Chegondi, Madhuradhar , Sullivan, Janice, Nason, Jennifer, Akhter, Murtaza , Kashiouris, Markos , Gal, Tamas, Karam, Oliver , Carvalho, Heloisa De, Khanna, Ashish K. , Garcia, Julio, Robinson, Samuel, Enwezor, Chukwunyelu Henry , Mendoza, Rafael
JAMA Pediatrics | October 3, 2022 | Volume: 176 | Issue: 12 | Pages: 1208
10.1001/jamapediatrics.2022.3611
ImportanceThere is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).ObjectiveTo determine whether the use of steroids within 2 days of admission for non–MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.Design, Setting, and ParticipantsThis cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non–MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.ExposureAdministration of steroids within 2 days of admission.Main Outcomes and MeasuresLength of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.ResultsA total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score–matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.Conclusions and RelevanceSteroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.
Early combination therapy with immunoglobulin and steroids is associated with shorter ICU length of stay in Multisystem Inflammatory Syndrome in Children (MIS‐C) associated with COVID‐19: A retrospective cohort analysis fro
Harthan, Aaron A. , Nadiger, Meghana , McGarvey, Jeremy , Hanson, Keith , Gharpure, Varsha , Miller, Aaron S., Reikoff, Ronald A., Kumar, Vishakha K. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID‐19 Registry Investigator, Danesh, Valerie , Gharpure, Varsha P , Bjornstad, Erica C. , Chiotos, Kathleen , Gajic, Ognjen , Walkey, Allan J. , Kashyap, Rahul , Tripathi, Sandeep , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID‐19 Registry Investigator
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy | June 6, 2022 | Volume: 42 | Issue: 7 | Pages: 529-539
AbstractObjectivesSuggested therapeutic options for Multisystem Inflammatory Syndrome in Children (MIS‐C) include intravenous immunoglobulins (IVIG) and steroids. Prior studies have shown the benefit of combination therapy with both agents on fever control or the resolution of organ dysfunction. The primary objective of this study was to analyze the impact of IVIG and steroids on hospital and ICU length of stay (LOS) in patients with MIS‐C associated with Coronavirus Disease 2019 (COVID‐19).Study DesignThis was a retrospective study on 356 hospitalized patients with MIS‐C from March 2020 to September 2021 (28 sites in the United States) in the Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID‐19 Registry. The effect of IVIG and steroids initiated in the first 2 days of admission, alone or in combination, on LOS was analyzed. Adjustment for confounders was made by multivariable mixed regression with a random intercept for the site.ResultsThe median age of the study population was 8.8 (Interquartile range (IQR) 4.0, 13) years. 247/356 (69%) patients required intensive care unit (ICU) admission during hospitalization. Overall hospital mortality was 2% (7/356). Of the total patients, 153 (43%) received IVIG and steroids, 33 (9%) received IVIG only, 43 (12%) received steroids only, and 127 (36%) received neither within 2 days of admission. After adjustment of confounders, only combination therapy showed a significant decrease of ICU LOS by 1.6 days compared to no therapy (exponentiated coefficient 0.71 [95% confidence interval 0.51, 0.97, p = 0.03]). No significant difference was observed in hospital LOS or the secondary outcome variable of the normalization of inflammatory mediators by Day 3.ConclusionsCombination therapy with IVIG and steroids initiated in the first 2 days of admission favorably impacts ICU but not the overall hospital LOS in children with MIS‐C.
Characterization and Outcomes of Hospitalized Children With Coronavirus Disease 2019: A Report From a Multicenter, Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) Registry
Bhalala, Utpal , Boman, Karen , Kumar, Vishakha K. , Retford, Lynn, Blatz, Allison M. , Dapul, Heda , Sayed, Imran A., Gharpure, Varsha , Irby, Katherine , Sanders, Ronald C., Heneghan, Julia A. , Thomas, Melissa K., Gupta, Manoj , Oulds, Franscene, Arteaga, Grace M. , Levy, Emily R. , Gupta, Neha , Kaufman, Margit, AbdelAty, Amr M. , Shlomovich, Mark , O'Meara, A M Iqbal, Kuehne, Joshua, Menon, Shina , Khandhar, Paras B., Miller, Aaron S., Barry, Suzanne, Danesh, Valerie , Zammit, Kimberly, Stulce, Casey , McGonagill, Patrick W. , Bercow, Asher, Amzuta, Ioana, Gupta, Sandeep , Almazyad, Mohammed , Pierre, Louisdon , Sendi, Prithvi , Ishaque, Sidra , Nawathe, Pooja , Lyons, Patrick G. , Bello, Imam Wada , Ari, Judith Ben, Kovačević, Tanja , Bansal, Vikas, Brinton, John T. , Rk, Kashyap, Bansal, Vikas , Kovačević, Tanja , Tierney, David M. , Polić, Branka , Markić, Joško , Asghar, Muhammad Sohaib , Galet, Colette , Carev, Dominko , Wen, Andy , Karam, Oliver , Bansal, Vikas , Levy, Emily R , Gharpure, Varsha P , Asghar, Muhammad S , Karam, Oliver , Gist, Katja M. , Tripathi, Sandeep , Chiotos, Kathleen , Verma, Sourabh , Bjornstad, Erica C. , Tofil, Nancy M. , Abdelaty, Amr, Medar, Shivanand , Khanna, Ashish , Anderson, Harry L, Akhter, Murtaza , Chen, Catherine , Walkey, Allan J. , Bihorac, Azra , Zimmerman, Jerry J. , Menon, Shina
Critical Care Medicine | August 13, 2021 | Volume: 50 | Issue: 1 | Pages: e40-e51
Objectives: Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry. Design: Retrospective study. Setting: Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry. Patients: Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021. Interventions: None. Measurements and Main Results: The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25–14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16–25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2–7.7 d) and 4 days (1.9–7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased. Conclusions: In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults.