Comparison of interleukin-6 plasma concentration in multisystem inflammatory syndrome in children associated with SARS-CoV-2 and pediatric sepsis
Author
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Díaz, Franco
Author
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Bustos B., Raúl
Author
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Yagnam Rojas, Felipe Nicolás
Author
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Karsies, Todd J.
Author
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Vásquez Hoyos, Pablo
Author
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Jaramillo Bustamante, Juan Camilo
Author
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González Dambrauskas, Sebastián
Author
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Drago Thibaut, Michele Denise
Author
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Cruces, Pablo
Admission date
dc.date.accessioned
2022-05-16T15:56:35Z
Available date
dc.date.available
2022-05-16T15:56:35Z
Publication date
dc.date.issued
2021
Cita de ítem
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Frontiers in Pediatrics November 2021 Volume 9 Article 756083
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Identifier
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10.3389/fped.2021.756083
Identifier
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https://repositorio.uchile.cl/handle/2250/185530
Abstract
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Importance: 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
levelmeasured 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.
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Lenguage
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en
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Publisher
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Frontiers Media
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Type of license
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Attribution-NonCommercial-NoDerivs 3.0 United States