{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T07:40:09Z","timestamp":1784014809509,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T00:00:00Z","timestamp":1656288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1 TR002377"],"award-info":[{"award-number":["UL1 TR002377"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Suggested therapeutic options for Multisystem Inflammatory Syndrome in Children (MIS\u2010C) include intravenous immunoglobulins (IVIG) and steroids. Prior studies have shown the benefit of combination therapy with both agents on fever control or the resolution of organ dysfunction. The primary objective of this study was to analyze the impact of IVIG and steroids on hospital and ICU length of stay (LOS) in patients with MIS\u2010C associated with Coronavirus Disease 2019 (COVID\u201019).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>This was a retrospective study on 356 hospitalized patients with MIS\u2010C from March 2020 to September 2021 (28 sites in the United States) in the Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID\u201019 Registry. The effect of IVIG and steroids initiated in the first 2\u2009days of admission, alone or in combination, on LOS was analyzed. Adjustment for confounders was made by multivariable mixed regression with a random intercept for the site.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age of the study population was 8.8 (Interquartile range (IQR) 4.0, 13) years. 247\/356 (69%) patients required intensive care unit (ICU) admission during hospitalization. Overall hospital mortality was 2% (7\/356). Of the total patients, 153 (43%) received IVIG and steroids, 33 (9%) received IVIG only, 43 (12%) received steroids only, and 127 (36%) received neither within 2\u2009days of admission. After adjustment of confounders, only combination therapy showed a significant decrease of ICU LOS by 1.6\u2009days compared to no therapy (exponentiated coefficient 0.71 [95% confidence interval 0.51, 0.97, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03]). No significant difference was observed in hospital LOS or the secondary outcome variable of the normalization of inflammatory mediators by Day 3.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Combination therapy with IVIG and steroids initiated in the first 2\u2009days of admission favorably impacts ICU but not the overall hospital LOS in children with MIS\u2010C.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2709","type":"journal-article","created":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T03:38:59Z","timestamp":1654486739000},"page":"529-539","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Early combination therapy with immunoglobulin and steroids is associated with shorter <scp>ICU<\/scp> length of stay in Multisystem Inflammatory Syndrome in Children (<scp>MIS\u2010C<\/scp>) associated with <scp>COVID\u201019<\/scp>: A retrospective cohort analysis from 28 U.S. Hospitals"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8471-4793","authenticated-orcid":false,"given":"Aaron A.","family":"Harthan","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy OSF Healthcare Children's Hospital of Illinois  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghana","family":"Nadiger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Illinois College of Medicine Peoria  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy S.","family":"McGarvey","sequence":"additional","affiliation":[{"name":"Healthcare Analytics OSF Healthcare  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6953-4375","authenticated-orcid":false,"given":"Keith","family":"Hanson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics 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