Dhanrajani, Anita D.
Mayo Clinic
University of Mississippi Medical Center
Citations 2
Postdischarge Glucocorticoid Use and Clinical Outcomes of Multisystem Inflammatory Syndrome in Children
Berbert, Laura , Dallas, Johnathan, Newhams, Margaret M. , Chen, Sabrina , Ardoin, Stacy P. , Basiaga, Matthew L. , Crandall, Hillary , Dhakal, Sanjeev, Sagcal‐Gironella, Anna Carmela P. , Huie, Livie , Jones, Madelyn, Kim, Susan , Lionetti, Geraldina, Mannion, Melissa L. , Muscal, Eyal , Tejtel, S. Kristen Sexson , Villacis-Nunez, D. Sofia , Wu, Eveline Y. , Zambrano, Laura D. , Campbell, Angela P. , Patel, Manish M. , Randolph, Adrienne G. , Investigators, Overcoming COVID-19, Kong, Michele , Tarquinio, Keiko M. , Kücükak, Suden, FitzGerald, Madyson M., Worden, Julie, Levy, Emily R. , Martin, Lora , Malloch, Lacy , Clouser, Katharine N. , Walker, Tracie C. , Hall, Mark W., Staat, Mary Allen , Loftis, Laura L. , Smith, Lincoln , Feldstein, Leora R. , Jackson, Ashley , Levy, Emily R , Randolph, Adrienne G , Kong, Michele , Mannion, Melissa L , Staat, Mary A , Son, Mary Beth F. , Young, Cameron C. , Canny, Susan , Dhanrajani, Anita D. , Hobbs, Charlotte V. , James, Karen, Prahalad, Sampath , Schulert, Grant S , Investigators, Overcoming COVID-19, Cvijanovich, Natalie Z , Zinter, Matt S. , Schwartz, Stephanie P. , Hall, Mark W. , McGuire, John K. , Tenforde, Mark W.
JAMA Network Open | November 11, 2022 | Volume: 5 | Issue: 11 | Pages: e2241622
10.1001/jamanetworkopen.2022.41622
ImportanceMinimal data are available regarding the postdischarge treatment of multisystem inflammatory syndrome in children (MIS-C).ObjectivesTo evaluate clinical characteristics associated with duration of postdischarge glucocorticoid use and assess postdischarge clinical course, laboratory test result trajectories, and adverse events in a multicenter cohort with MIS-C.Design, Setting, and ParticipantsThis retrospective cohort study included patients with MIS-C hospitalized with severe illness and followed up for 3 months in an ambulatory setting. Patients younger than 21 years who were admitted between May 15, 2020, and May 31, 2021, at 13 US hospitals were included. Inclusion criteria were inpatient treatment comprising intravenous immunoglobulin, diagnosis of cardiovascular dysfunction (vasopressor requirement or left ventricular ejection fraction ≤55%), and availability of complete outpatient data for 3 months.ExposuresGlucocorticoid treatment.Main Outcomes and MeasuresMain outcomes were patient characteristics associated with postdischarge glucocorticoid treatment, laboratory test result trajectories, and adverse events. Multivariable regression was used to evaluate factors associated with postdischarge weight gain (≥2 kg in 3 months) and hyperglycemia during illness.ResultsAmong 186 patients, the median age was 10.4 years (IQR, 6.7-14.2 years); most were male (107 [57.5%]), Black non-Hispanic (60 [32.3%]), and Hispanic or Latino (59 [31.7%]). Most children were critically ill (intensive care unit admission, 163 [87.6%]; vasopressor receipt, 134 [72.0%]) and received inpatient glucocorticoid treatment (178 [95.7%]). Most were discharged with continued glucocorticoid treatment (173 [93.0%]); median discharge dose was 42 mg/d (IQR, 30-60 mg/d) or 1.1 mg/kg/d (IQR, 0.7-1.7 mg/kg/d). Inpatient severity of illness was not associated with duration of postdischarge glucocorticoid treatment. Outpatient treatment duration varied (median, 23 days; IQR, 15-32 days). Time to normalization of C-reactive protein and ferritin levels was similar for glucocorticoid duration of less than 3 weeks vs 3 or more weeks. Readmission occurred in 7 patients (3.8%); none was for cardiovascular dysfunction. Hyperglycemia developed in 14 patients (8.1%). Seventy-five patients (43%) gained 2 kg or more after discharge (median 4.1 kg; IQR, 3.0-6.0 kg). Inpatient high-dose intravenous and oral glucocorticoid therapy was associated with postdischarge weight gain (adjusted odds ratio, 6.91; 95% CI, 1.92-24.91).Conclusions and RelevanceIn this multicenter cohort of patients with MIS-C and cardiovascular dysfunction, postdischarge glucocorticoid treatment was often prolonged, but clinical outcomes were similar in patients prescribed shorter courses. Outpatient weight gain was common. Readmission was infrequent, with none for cardiovascular dysfunction. These findings suggest that strategies are needed to optimize postdischarge glucocorticoid courses for patients with MIS-C.
Life-Threatening Complications of Influenza vs Coronavirus Disease 2019 (COVID-19) in US Children
Halasa, Natasha , Young, Cameron C. , Newhams, Margaret M. , Nakamura, Mari , Levy, Emily R. , Soma, Vijaya L, Talj, Rana, Fitzgerald, Julie C. , Mack, Elizabeth H. , Schuster, Jennifer E. , Coates, Bria M. , Hall, Mark W. , Schwarz, Adam J. , Kong, Michele, Spinella, Philip C. , Loftis, Laura L. , McLaughlin, Gwenn E., Rowan, Courtney M. , Nofziger, Ryan A. , Babbitt, Christopher , Bowens, Cindy , Flori, Heidi R. , Gertz, Shira J. , Zinter, Matt S. , Hume, Janet R. , Singh, Aalok R. , Crandall, Hillary A, Cullimore, Melissa L. , Patel, Manish M. , Randolph, Adrienne G. , Influenza, for the Pediatric Intensive Care, Investigators, Overcoming COVID-19, Kong, Michele, Gaspers, Mary Glas , Sanders, Ronald C., Irby, Katherine , Peter, Mourani, Harvey, Helen , Osborne, Christina , Sara, Shankman, Mourani, Peter M. , Port, Emily, Van, Kevin A, Carroll, Christopher L. , Tarquinio, Keiko M. , Coates, Bria M, Wellnitz, Kari , Bhoojhawon, Guru , Sullivan, Janice E, Bradford, Tamara T. , Riggs, Becky J. , Randolph, Adrienne G, Chen, Sabrina R., Carroll, Ryan W. , Yager, Phoebe H. , Heidemann, Sabrina M. , Hume, Janet R, Martin, Lora , Malloch, Lacy , Inagaki, Kengo , Schuster, Jennifer E, Kietzman, Abigail , Clouser, Katharine N. , Kleinman, Lawrence C. , Horwitz, Steven M. , Keenaghan, Michael , Doymaz, Sule , Walker, Tracie C. , Hall, Mark W, Lansell, Amanda , Staat, Mary Allen , Carcillo, Joseph A. , Smallcomb, Laura , Halasa, Natasha B, Stewart, Laura S , Romero, Yesenia, Hayek, Haya , Bowens, Cindy, Maamari, Mia , Crandall, Hillary , Smith, Lincoln , Kong, Michele , Young, Cameron C , Randolph, Adrienne G , Levy, Emily R , Spinella, Philip C , Kong, Michele , Hume, Janet R , Staat, Mary A , Gertz, Shira J , Spieker, Andrew J. , Olson, Samantha M. , Amarin, Justin Z. , Moffitt, Kristin , Weiss, Scott L. , Maddux, Aline B. , Schwartz, Stephanie P. , Kong, Michele, Hobbs, Charlotte V. , Bembea, Melania M. , Giuliano, John S. , Cvijanovich, Natalie Z , Thomas, Neal J. , Influenza, for the Pediatric Intensive Care, Investigators, Overcoming COVID-19, Kong, Michele, Typpo, Katri , Michelson, Kelly Nicole , Coates, Bria M, Sullivan, Janice E, Montgomery, Vicki , Havlin, Kevin , Randolph, Adrienne G, Fernandes, Neil D. , Hume, Janet R, Dhanrajani, Anita D. , Schuster, Jennifer E, Hill, Shannon, McCulloh, Russell J. , Li, Simon , Ratner, Adam J. , Dapul, Heda , Harwayne‐Gidansky, Ilana , Hymes, Saul , Hall, Mark W, Shein, Steven L. , Fink, Ericka L. , Halasa, Natasha B, Muñoz, Álvaro Coronado , Bowens, Cindy, McGuire, John K.
Clinical Infectious Diseases | June 19, 2022 | Volume: 76 | Issue: 3 | Pages: e280-e290
Abstract Background Clinical differences between critical illness from influenza infection vs coronavirus disease 2019 (COVID-19) have not been well characterized in pediatric patients. Methods We compared demographics, clinical characteristics, and outcomes of US children (aged 8 months to 17 years) admitted to the intensive care or high-acuity unit with influenza or COVID-19. Using mixed-effects models, we assessed the odds of death or requiring life support for influenza vs COVID-19 after adjustment for age, sex, race and Hispanic origin, and underlying conditions including obesity. Results Children with influenza (n = 179) were younger than those with COVID-19 (n = 381; median, 5.2 years vs 13.8 years), less likely to be non-Hispanic Black (14.5% vs 27.6%) or Hispanic (24.0% vs 36.2%), and less likely to have ≥1 underlying condition (66.4% vs 78.5%) or be obese (21.4% vs 42.2%), and a shorter hospital stay (median, 5 days vs 7 days). They were similarly likely to require invasive mechanical ventilation (both 30.2%), vasopressor support (19.6% and 19.9%), or extracorporeal membrane oxygenation (2.2% and 2.9%). Four children with influenza (2.2%) and 11 children with COVID-19 (2.9%) died. The odds of death or requiring life support in children with influenza vs COVID-19 were similar (adjusted odds ratio, 1.30; 95% confidence interval, .78–2.15; P = .32). Conclusions Despite differences in demographics and clinical characteristics of children with influenza or COVID-19, the frequency of life-threatening complications was similar. Our findings highlight the importance of implementing prevention measures to reduce transmission and disease severity of influenza and COVID-19.