Comparison of Interleukin-6 plasma concentration in multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 and pediatric sepsis

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dc.contributor.authorDíaz, Francoes
dc.contributor.authorBusto B., Raúles
dc.contributor.authorYagnam, Felipees
dc.contributor.authorJ. Karsies, Toddes
dc.contributor.authorVásquez-Hoyos, Pabloes
dc.contributor.authorJaramillo-Bustamante, Juan-Camiloes
dc.contributor.authorGonzalez-Dambrauskas, Sebastiánes
dc.contributor.authorDrago, Michellees
dc.contributor.authorCruces, Pabloes
dc.date.accessioned2021-12-14T19:41:53Z
dc.date.available2021-12-14T19:41:53Z
dc.date.issued2021-11-15
dc.description.abstractImportance: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection is thought to be driven by a post-viral dysregulated immune response, where interleukin 6 (IL-6) might have a central role. In this setting, IL-6 inhibitors are prescribed as immunomodulation in cases refractory to standard therapy. Objective: To compare plasma IL-6 concentration between critically ill children with MIS-C and sepsis. Design: A retrospective cohort study from previously collected data. Setting: Individual patient data were gathered from three different international datasets. Participants: Critically ill children between 1 month-old and 18 years old, with an IL-6 level measured within 48 h of admission to intensive care. Septic patients were diagnosed according to Surviving Sepsis Campaign definition and MIS-C cases by CDC criteria. We excluded children with immunodeficiency or immunosuppressive therapy. Exposure: None. Main Outcome(s) and Measure(s): The primary outcome was IL-6 plasma concentration in MIS-C and sepsis group at admission to the intensive care unit. We described demographics, inflammatory biomarkers, and clinical outcomes for both groups. A subgroup analysis for shock in each group was done. Results: We analyzed 66 patients with MIS-C and 44 patients with sepsis. MIS-C cases were older [96 (48, 144) vs. 20 (5, 132) months old, p < 0.01], but no differences in sex (41 vs. 43% female, p = 0.8) compared to septic group. Mechanical ventilation use was 48.5 vs. 93% (p < 0.001), vasoactive drug use 79 vs. 66% (p = 0.13), and mortality 4.6 vs. 34.1% (p < 0.01) in MIS-C group compared to sepsis. IL-6 was 156 (36, 579) ng/dl in MIS-C and 1,432 (122, 6,886) ng/dl in sepsis (p < 0.01), while no significant differences were observed in procalcitonin (PCT) and c-reactive protein (CRP). 52/66 (78.8%) patients had shock in MIS-C group, and 29/44 (65.9%) had septic shock in sepsis group. Septic shock had a significantly higher plasma IL-6 concentration than the three other sub-groups. Differences in IL-6, CRP, and PCT were not statistically different between MIS-C with and without shock. Conclusions and Relevance: IL-6 plasma concentration was elevated in critically ill MIS-C patients but at levels much lower than those of sepsis. Furthermore, IL-6 levels don’t discriminate between MIS-C cases with and without shock. These results lead us to question the role of IL-6 in the pathobiology of MIS-C, its diagnosis, clinical outcomes, and, more importantly, the off-label use of IL-6 inhibitors for these cases.es
dc.identifier.citationFrontiers Pediatrics, Vol. 9, 756083 (2021) p. 1-6en
dc.identifier.issn2296-2360
dc.identifier.orcid0000-0003-4763-074Xes
dc.identifier.orcid10.3389/fped.2021.756083es
dc.identifier.orcidhttps://doi.org/10.3389/fped.2021.756083
dc.identifier.urihttp://hdl.handle.net/20.500.12254/2114
dc.language.isoenes
dc.publisherFrontiers in pediatricsen
dc.rightsAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/3.0/cl/en
dc.subject.otherCOVID-19es
dc.subject.otherMIS-Ces
dc.subject.othersepsises
dc.subject.otherinterleukin-6 (IL-6)es
dc.subject.othershockes
dc.titleComparison of Interleukin-6 plasma concentration in multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 and pediatric sepsises
dc.typeArtículoes
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