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Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score

In this observational study, we report the clinical, therapeutics and outcome features of 23 patients with multisystem inflammatory syndrome (MIS-C) who have been treated in Gaslini Children Hospital (Genoa, Italy) with a multistep antinflammatory treatment protocol, based on disease severity at adm...

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Autores principales: Brisca, Giacomo, Consolaro, Alessandro, Caorsi, Roberta, Pirlo, Daniela, Tuo, Giulia, Campanello, Claudia, Castagnola, Elio, Moscatelli, Andrea, Gattorno, Marco, Ravelli, Angelo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721096/
https://www.ncbi.nlm.nih.gov/pubmed/34988039
http://dx.doi.org/10.3389/fped.2021.783745
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author Brisca, Giacomo
Consolaro, Alessandro
Caorsi, Roberta
Pirlo, Daniela
Tuo, Giulia
Campanello, Claudia
Castagnola, Elio
Moscatelli, Andrea
Gattorno, Marco
Ravelli, Angelo
author_facet Brisca, Giacomo
Consolaro, Alessandro
Caorsi, Roberta
Pirlo, Daniela
Tuo, Giulia
Campanello, Claudia
Castagnola, Elio
Moscatelli, Andrea
Gattorno, Marco
Ravelli, Angelo
author_sort Brisca, Giacomo
collection PubMed
description In this observational study, we report the clinical, therapeutics and outcome features of 23 patients with multisystem inflammatory syndrome (MIS-C) who have been treated in Gaslini Children Hospital (Genoa, Italy) with a multistep antinflammatory treatment protocol, based on disease severity at admission. Patients were initially assigned to four severity classes on admission and treated accordingly. The therapeutic options ranged from IV immunoglobulin alone to a combination of IVIG plus pulses of methylprednisolone plus anakinra for patients with marked cardiac function impairment or signs of macrophage activation syndrome, with rapid treatment escalation in case of inadequate therapeutic response. With the application of this therapeutic strategy, no patient required admission to Intensive Care Unit (ICU) or invasive mechanical ventilation, and no inotropic drugs administration was required. Early aggressive treatment of MIS-C, with therapeutic interventions modulated based on the severity of clinical manifestations may help to prevent the progression of the inflammatory process and to avoid the need of admission to the ICU. A timely intervention with anti-IL-1 blockers can play a pivotal role in very severe patients that are at risk to have an incomplete response to immunoglobulins and steroids.
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spelling pubmed-87210962022-01-04 Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score Brisca, Giacomo Consolaro, Alessandro Caorsi, Roberta Pirlo, Daniela Tuo, Giulia Campanello, Claudia Castagnola, Elio Moscatelli, Andrea Gattorno, Marco Ravelli, Angelo Front Pediatr Pediatrics In this observational study, we report the clinical, therapeutics and outcome features of 23 patients with multisystem inflammatory syndrome (MIS-C) who have been treated in Gaslini Children Hospital (Genoa, Italy) with a multistep antinflammatory treatment protocol, based on disease severity at admission. Patients were initially assigned to four severity classes on admission and treated accordingly. The therapeutic options ranged from IV immunoglobulin alone to a combination of IVIG plus pulses of methylprednisolone plus anakinra for patients with marked cardiac function impairment or signs of macrophage activation syndrome, with rapid treatment escalation in case of inadequate therapeutic response. With the application of this therapeutic strategy, no patient required admission to Intensive Care Unit (ICU) or invasive mechanical ventilation, and no inotropic drugs administration was required. Early aggressive treatment of MIS-C, with therapeutic interventions modulated based on the severity of clinical manifestations may help to prevent the progression of the inflammatory process and to avoid the need of admission to the ICU. A timely intervention with anti-IL-1 blockers can play a pivotal role in very severe patients that are at risk to have an incomplete response to immunoglobulins and steroids. Frontiers Media S.A. 2021-12-20 /pmc/articles/PMC8721096/ /pubmed/34988039 http://dx.doi.org/10.3389/fped.2021.783745 Text en Copyright © 2021 Brisca, Consolaro, Caorsi, Pirlo, Tuo, Campanello, Castagnola, Moscatelli, Gattorno and Ravelli. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Brisca, Giacomo
Consolaro, Alessandro
Caorsi, Roberta
Pirlo, Daniela
Tuo, Giulia
Campanello, Claudia
Castagnola, Elio
Moscatelli, Andrea
Gattorno, Marco
Ravelli, Angelo
Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score
title Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score
title_full Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score
title_fullStr Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score
title_full_unstemmed Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score
title_short Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score
title_sort timely recognition and early multi-step antinflammatory therapy may prevent icu admission of patients with mis-c: proposal for a severity score
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721096/
https://www.ncbi.nlm.nih.gov/pubmed/34988039
http://dx.doi.org/10.3389/fped.2021.783745
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