87 - The association between early systemic corticosteroid therapy and hospital length of stay in patients with Multisystem Inflammatory Syndrome in Children (MIS-C).

Poster Number: 87
Publication Number: 87.106

Vincenzo Maniaci, Nicklaus Children’s Hospital, miami, FL, United States; Torrie L. Reynolds-Herbst, Nicklaus Children’s Hospital, Miami, FL, United States; David Lowe, Nicklaus Children’s Hospital, Miami, FL, United States; Juan Lozano, Florida International University Herbert Wertheim College of Medicine, Miami, FL, United States

Background:
Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) often require hospital admission and critical care support. Empiric treatment of MIS-C has included regimens of IVIG, systemic corticosteroids, and/or immunomodulatory agents. To our knowledge, there is no standardized approach to when steroid therapy should be initiated in the course of illness for a patient with MIS-C.

Objective:
To determine if early initiation of systemic corticosteroid therapy (defined as within 24 hours of hospitalization) is associated with the duration of hospital length of stay (LOS) in patients diagnosed with MIS-C.

Design/Methods:
Single center retrospective cohort study of children and adolescents < 21 years of age presenting to a freestanding tertiary care children’s hospital between March 2020 and September 2021 who were hospitalized with MIS-C, as per the CDC case definition. Cases were obtained from an institutional MIS-C log. Manual chart review was performed to confirm the MIS-C diagnosis and inclusion criteria. Patients with culture proven sepsis and/or those who had received IVIG or steroids within 30 days before were excluded. Patient demographics, clinical characteristics and hospital course were collected, and REDCap was used to create a de-identified database. For analysis we used a multivariate linear regression model, controlling for a priori-defined potential confounders.

Results: A total of 56 patients met inclusion criteria, of which 38 received systemic corticosteroids and were included in the analysis. The mean time from admission to steroid administration was 9.76 hours (SD=7.74) in the early group, and 44.59 hours (SD=14.22) in the late group. There was a statistically significant difference in baseline characteristics of patients receiving early vs late steroids in initial CRP, procalcitonin, BNP and cardiac dysfunction (Table 1). Early initiation of systemic corticosteroids within 24 hours of hospital admission for MIS-C was associated with a decreased hospital LOS. In patients treated with early steroids, LOS was 78.7 hours less (95% CI -152.2 to -5.3, p=0.037) than in those who received late steroids (Table 2).Conclusion(s): Among children and adolescents with MIS-C, initiating systemic corticosteroid therapy within 24 hours of their hospital admission was associated with decreased length of stay. Initiation of steroids from the Emergency Department upon diagnosis is therefore an important consideration. This data can provide additional evidence to guide management of patients with MIS-C as the pandemic continues to progress, until evidence from RCTs is available.
Comparison of baseline characteristics between patients who received early steroids vs late steroidsTable 1
Multivariate linear regression model for the association between early initiation of steroids and hospital length of stay in MISC patientsTable 2