{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:39:54Z","timestamp":1760060394406,"version":"build-2065373602"},"reference-count":95,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Optimal treatment for non-critically ill multisystem inflammatory syndrome in children (MIS-C) remains unclear. We evaluated short-term outcomes in mild to moderately ill hospitalized MIS-C patients fulfilling CDC 2020 and CDC\/CTSE 2023 criteria and treated between April 2020 and March 2022 with either intravenous immunoglobulin (IVIG) monotherapy (Group A, n = 17) or IVIG plus corticosteroids (GC) (Group B, n = 22). Cardiovascular clinical parameters, inflammatory markers, and cardiac imaging were compared on days 1, 3, and 5 relative to day 0. The two groups had no significant differences in demographics or illness severity. Group B showed improvement in heart rate (17.8; 95% CI [9.74, 25.8]), mean blood pressure (5.63 [1.61, 9.64]), and body temperature (1.45 [0.94, 1.95]) by day 1, followed by improvement in albumin (0.43 [0.2, 0.84]), CRP (7.56 [3.0, 12.11]), D-dimer (2344 [488.7, 4200.2]), ferritin (1448 [\u2212609.4, 3505.5]), fibrinogen (110 [44.4, 176]), lymphocyte count (1006 [63.5, 1948]), and NT-proBNP (2901 [\u2212349.3, 6153]) by day 3 and left ventricular ejection fraction by day 4\u20135 (3.84 [0.55, 8.23]). All results were statistically significant (p &lt; 0.05). Group A required more additional therapies, with no difference in hospital stay. Our study concludes that combined IVIG and GC therapy yielded better short-term outcomes than IVIG monotherapy in this patient population, with improvement in cardiovascular clinical parameters preceding changes in inflammatory markers and cardiac imaging.<\/jats:p>","DOI":"10.3390\/jcdd12090324","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T07:30:29Z","timestamp":1756107029000},"page":"324","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Immunomodulatory Therapies for Cardiovascular Clinical and Inflammatory Markers Outcomes in Mild to Moderately Ill Hospitalized Multisystem Inflammatory Syndrome in Children Patients"],"prefix":"10.3390","volume":"12","author":[{"given":"Rashmitha","family":"Dachepally","sequence":"first","affiliation":[{"name":"Department of Pediatric Critical Care Medicine, Children\u2019s Nebraska, Omaha, NE 68114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reem","family":"Sarkis","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Medicine, Akron Children\u2019s Hospital, Akron, OH 44302, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8700-970X","authenticated-orcid":false,"given":"Alvaro","family":"DonaireGarcia","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care, Driscoll Children\u2019s Hospital Rio Grande Valley, Edinburg, TX 78539, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghana","family":"Kovvuri","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care Medicine, Driscoll Children\u2019s Hospital, Corpus Christi, TX 78411, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karunya","family":"Jayasimha","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, WVU Children\u2019s, Morgantown, WV 26506, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrija","family":"Chaturvedi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Rainbow Babies & Children\u2019s Hospital, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5222-2260","authenticated-orcid":false,"given":"Amr","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Critical Care, WVU Children\u2019s, Morgantown, WV 26506, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirada","family":"Panupattanapong","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rheumatology, Cleveland Clinic Children\u2019s, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samir","family":"Latifi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care, Cleveland Clinic Children\u2019s, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemant","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Medicine, Akron Children\u2019s Hospital, Akron, OH 44302, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1056\/NEJMoa2021680","article-title":"Multisystem inflammatory syndrome in U.S. children and adolescents","volume":"383","author":"Feldstein","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101516","DOI":"10.1016\/j.ppedcard.2022.101516","article-title":"A comparison of Kawasaki Disease and multisystem inflammatory syndrome in children","volume":"65","author":"Wessels","year":"2022","journal-title":"Prog. Pediatr. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jaci.2020.10.008","article-title":"COVID-19-associated multisystem inflamma-tory syndrome in children (MIS-C): A novel disease that mimics toxic shock syndrome-the superantigen hy-pothesis","volume":"147","author":"Porritt","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1016\/j.jaci.2022.02.028","article-title":"Distinguishing immune activation and inflammatory signatures of multisystem inflammatory syndrome in children (MIS-C) versus hemophagocytic lymphohistiocytosis (HLH)","volume":"149","author":"Kumar","year":"2022","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_5","unstructured":"Royal College of Paediatrics and Child Health (2025, April 15). Guidance: Paediatric Multisystem Inflammatory Syndrome Temporally Associated with COVID-19. Available online: https:\/\/www.rcpch.ac.uk\/resources\/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19."},{"key":"ref_6","unstructured":"for Disease Control and Prevention (2025, April 15). Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 Summary and Recommendations 2020, Available online: https:\/\/emergency.cdc.gov\/han\/2020\/han00432.asp."},{"key":"ref_7","unstructured":"World Health Organization (2025, April 15). Multisystem Inflammatory Syndrome in Children and Adolescents with COVID-19. Available online: https:\/\/www.who.int\/news-room\/commentaries\/detail\/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19."},{"key":"ref_8","unstructured":"Centers for Disease Control and Prevention (2025, April 15). National Notifiable Diseases Surveillance System. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection 2023 Case Definition, Available online: https:\/\/ndc.services.cdc.gov\/case-definitions\/multisystem-inflammatory-syndrome-in-children-mis-c-2023."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1002\/art.41454","article-title":"American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS\u2013CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1","volume":"72","author":"Henderson","year":"2020","journal-title":"Arthritis Rheumatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S2352-4642(20)30304-7","article-title":"A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): Results of a national Delphi process","volume":"5","author":"Harwood","year":"2021","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101232","DOI":"10.1016\/j.ppedcard.2020.101232","article-title":"COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach","volume":"57","author":"Hennon","year":"2020","journal-title":"Prog. Pediatr. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1001\/jama.2021.0694","article-title":"Association of intravenous im-munoglobulins plus methylprednisolone vs. immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children","volume":"325","author":"Ouldali","year":"2021","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1056\/NEJMoa2102605","article-title":"Multisystem inflamma-tory syndrome in children: Initial therapy and outcomes","volume":"385","author":"Son","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2282","DOI":"10.1161\/CIRCULATIONAHA.120.050147","article-title":"Addition of corticosteroids to immunoglobulins is associated with recovery of cardiac function in multi-inflammatory syndrome in children","volume":"142","author":"Belhadjer","year":"2020","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa2102968","article-title":"Treatment of multisystem inflammatory syndrome in children","volume":"385","author":"McArdle","year":"2021","journal-title":"New Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1001\/jamapediatrics.2022.0292","article-title":"Short-term outcomes of corticosteroid monotherapy in multisystem inflammatory syn-drome in children","volume":"176","author":"Jones","year":"2022","journal-title":"JAMA Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e184","DOI":"10.1016\/S2665-9913(23)00029-2","article-title":"Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: A propensity-weighted cohort study","volume":"5","author":"Vito","year":"2023","journal-title":"Lancet Rheumatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e2022061173","DOI":"10.1542\/peds.2022-061173","article-title":"Immunomodulatory therapy for MIS-C","volume":"152","author":"Ouldali","year":"2023","journal-title":"Pediatrics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/S2352-4642(23)00020-2","article-title":"Methylprednisolone versus intravenous immunoglobulins in children with pae-diatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): An open-label, multicentre, randomised trial","volume":"7","author":"Welzel","year":"2023","journal-title":"Lancet Child. Adolesc. Health."},{"key":"ref_20","unstructured":"RECOVERY Collaborative Group (2024). Immunomodulatory therapy in children with paediatric inflammatory mul-tisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS, MIS-C; RECOVERY): A randomised, controlled, open-label, platform trial. Lancet Child Adolesc. Health, 8, 190\u2013200."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/art.42062","article-title":"American College of Rheumatology clinical guidance for multisystem inflam-matory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: Version 3","volume":"74","author":"Henderson","year":"2022","journal-title":"Arthritis Rheumatol."},{"key":"ref_22","unstructured":"(2025, April 15). American Academy of Pediatrics Multisystem Inflammatory Syndrome in Children (MIS-C) Interim Guidance. Available online: https:\/\/www.aap.org\/en\/pages\/2019-novel-coronavirus-covid-19-infections\/clinical-guidance\/multisystem-inflammatory-syndrome-in-children-mis-c-interim-guidance."},{"key":"ref_23","unstructured":"World Health Organization (2025, April 15). Living Guidance for Clinical Management of COVID-19. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-clinical-2021-2."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1001\/jama.2020.10369","article-title":"Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2","volume":"324","author":"Whittaker","year":"2020","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e178","DOI":"10.1097\/PCC.0000000000002598","article-title":"Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 in a Children\u2019s Hospital in New York City: Patient characteristics and an institutional protocol for evaluation, management, and follow-up","volume":"22","author":"Jonat","year":"2020","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e390","DOI":"10.1097\/INF.0000000000003260","article-title":"Recent Experience: Corticosteroids as a First-line Therapy in Children With Multisystem Inflammatory Syndrome and COVID-19-related Myocardial Damage","volume":"40","author":"Vukomanovic","year":"2021","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ajem.2024.06.030","article-title":"MIS-C Treatment: Is gluco-corticoid monotherapy enough for mild cases?","volume":"83","author":"Kara","year":"2024","journal-title":"Am. J. Emerg. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jpeds.2020.06.045","article-title":"Multisystem Inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (MIS-C): A multi-institutional study from New York City","volume":"224","author":"Kaushik","year":"2020","journal-title":"J. Pediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2452","DOI":"10.1001\/jama.2022.8025","article-title":"Severity and inci-dence of Multisystem Inflammatory Syndrome in children during 3 SARS-CoV-2 pandemic waves in Israel","volume":"327","author":"Levy","year":"2022","journal-title":"JAMA"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1001\/jamapediatrics.2023.3117","article-title":"International pediatric COVID-19 severity over the course of the pandemic","volume":"177","author":"Zhu","year":"2023","journal-title":"JAMA Pediatr."},{"key":"ref_31","first-page":"51","article-title":"Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation","volume":"38","author":"Radia","year":"2021","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Jonat, B., Geneslaw, A.S., Capone, C.A., Shah, S., Bartucca, L., Sewell, T.B., Acker, K.P., Mitchell, E., and Cheung, E.W. (2023). Early treatment of multisystem inflammatory syndrome in children. Pediatrics, 152.","DOI":"10.1542\/peds.2023-061297"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1089\/ped.2023.0024","article-title":"Assessing the response of biomarkers to anti-inflammatory medications in PIMS-TS by longitudinal multilevel modeling: Real-world data from a UK Tertiary Center","volume":"36","author":"Tonge","year":"2023","journal-title":"Pediatr. Allergy, Immunol. Pulmonol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1097\/PCC.0000000000001191","article-title":"Validation of the vasoactive-inotropic score in pediatric sepsis*","volume":"18","author":"McIntosh","year":"2017","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s00431-022-04649-8","article-title":"Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies","volume":"182","author":"Tagarro","year":"2023","journal-title":"Eur. J. Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e006979","DOI":"10.1161\/CIRCIMAGING.117.006979","article-title":"Relationship of echocardiographic Z scores adjusted for body surface area to age, sex, race, and ethnicity: The Pediatric Heart Network Normal Echocardiogram Database","volume":"10","author":"Lopez","year":"2017","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"103265","DOI":"10.1016\/j.jaut.2024.103265","article-title":"The HyperPed-COVID international registry: Impact of age of onset, disease presentation and geographical distri-bution on the final outcome of MIS-C","volume":"147","author":"Caorsi","year":"2024","journal-title":"J. Autoimmun."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1007\/s00431-023-05383-5","article-title":"Multisystem inflammatory syndrome in children (MIS-C): A nationwide collaborative study in the Greek population","volume":"183","author":"Lampidi","year":"2024","journal-title":"Eur. J. Pediatr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7104a1","article-title":"Council of State and Territorial Epidemiologists\/CDC Surveillance Case Defi-nition for Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection\u2014United States","volume":"71","author":"Melgar","year":"2022","journal-title":"MMWR Recomm. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1007\/s00246-020-02391-2","article-title":"Paediatric inflammatory multisystem syndrome: Temporally associated with SARS-CoV-2 (PIMS-TS): Cardiac features, management and short-term outcomes at a UK tertiary paediatric hospital","volume":"41","author":"Ramcharan","year":"2020","journal-title":"Pediatr. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e002344","DOI":"10.1136\/bmjpo-2023-002344","article-title":"Clinical presentation, diagnosis and management of multisystem inflammatory syndrome in children (MIS-C): A systematic review","volume":"8","author":"Abbas","year":"2024","journal-title":"BMJ Paediatr. Open"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s12519-024-00798-y","article-title":"Treatment of multisystem inflammatory syndrome in children","volume":"20","author":"Tong","year":"2024","journal-title":"World J. Pediatr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1001\/jama.2021.2091","article-title":"Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19","volume":"325","author":"Feldstein","year":"2021","journal-title":"JAMA"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00246-021-02738-3","article-title":"Echocardiographic findings and correlation with laboratory values in multisystem inflammatory syndrome in children (MIS-C) Associated with COVID-19","volume":"43","author":"Kavurt","year":"2021","journal-title":"Pediatr. Cardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"109877","DOI":"10.1016\/j.clim.2023.109877","article-title":"Comparing the immune abnormalities in MIS-C to healthy children and those with inflammatory disease reveals distinct inflammatory cytokine production and a monofunctional T cell response","volume":"259","author":"Butters","year":"2023","journal-title":"Clin. Immunol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Rajamanickam, A., Kumar, N.P., Venkataraman, A., Varadarjan, P., Selladurai, E., Sankaralingam, T., Thiruvengadam, K., Selvam, R., Thimmaiah, A., and Natarajan, S. (2024). Sex-specific differences in systemic immune responses in MIS-C children. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-52116-1"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e261","DOI":"10.1542\/hpeds.2022-006534","article-title":"NT-proBNP lev-els following IVIG treatment of multisystem inflammatory syndrome in children","volume":"12","author":"Schmitz","year":"2022","journal-title":"Hosp. Pediatr."},{"key":"ref_50","first-page":"84","article-title":"Comparison of plasma inflammatory biomarkers between MIS-C and potentially serious infections in pediatric patients","volume":"20","year":"2024","journal-title":"Reumatol. Clin. (Engl. Ed.)"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1002\/phar.2709","article-title":"Early combination therapy with im-munoglobulin and steroids is associated with shorter ICU length of stay in Multisystem Inflammatory Syn-drome in Children (MIS-C) associated with COVID-19: A retrospective cohort analysis from 28 U.S. Hospitals","volume":"42","author":"Harthan","year":"2022","journal-title":"Pharmacotherapy"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e2021052702","DOI":"10.1542\/peds.2021-052702","article-title":"IVIG compared with IVIG plus infliximab in Multisystem Inflammatory Syn-drome in Children","volume":"148","author":"Cole","year":"2021","journal-title":"Pediatrics."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3733","DOI":"10.1007\/s00431-022-04584-8","article-title":"Risk factors of a severe course of pediatric multi-system inflammatory syndrome temporally associated with COVID-19","volume":"181","author":"Stasiak","year":"2022","journal-title":"Eur. J. Pediatr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.ijcard.2022.05.030","article-title":"Changes in the cardiovascular system in children with pediatric multisystem inflammatory syndrome temporally associated with COVID-19\u2014A single center experience","volume":"361","author":"Stasiak","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e28927","DOI":"10.1002\/jmv.28927","article-title":"Systematic review and meta-analysis on the serological, immunological, and cardiac parameters of the multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 infection","volume":"95","author":"Mamishi","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Pandit, M., and Frishman, W.H. (2024). Multisystem inflammatory syndrome in children during the COVID-19 pandemic: A review of clinical manifestations, Cardiac Complications and Medical Management. Cardiol. Rev.","DOI":"10.1097\/CRD.0000000000000565"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s00540-024-03323-7","article-title":"Multisystem inflammatory syndrome in children: An Umbrella review","volume":"38","author":"Shioji","year":"2024","journal-title":"J. Anesthesia"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"4358","DOI":"10.1002\/jmv.26951","article-title":"The inflammatory markers of multisystem inflammatory syndrome in children (MIS-C) and adolescents associated with COVID-19: A meta-analysis","volume":"93","author":"Zhao","year":"2021","journal-title":"J. Med Virol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1007\/s13312-021-2277-4","article-title":"Clinical profile and short-term outcome of chil-dren with SARS-CoV-2 related Multisystem Inflammatory Syndrome (MIS-C) treated with pulse methylpred-nisolone","volume":"58","author":"Sugunan","year":"2021","journal-title":"Indian Pediatr."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.cell.2020.09.034","article-title":"Mapping Systemic Inflammation and Antibody Responses in Multisystem Inflammatory Syndrome in Children (MIS-C)","volume":"183","author":"Gruber","year":"2020","journal-title":"Cell"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1172\/JCI113000","article-title":"Study of the molecular mechanism of decreased liver synthesis of albumin in inflammation","volume":"79","author":"Moshage","year":"1987","journal-title":"J. Clin. Investig."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Pathak, A., and Agrawal, A. (2019). Evolution of C-Reactive Protein. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.00943"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1046\/j.1365-2141.2001.03061.x","article-title":"Interleukin-6 and hemostasis","volume":"115","author":"Kerr","year":"2001","journal-title":"Br. J. Haematol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s00296-020-04749-4","article-title":"Severe COVID-19, multisystem in-flammatory syndrome in children, and Kawasaki disease: Immunological mechanisms, clinical manifestations and management","volume":"41","author":"Kabeerdoss","year":"2021","journal-title":"Rheumatol. Int."},{"key":"ref_65","first-page":"e41950","article-title":"Cardiovascular manifestations of multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19","volume":"15","author":"Oragui","year":"2023","journal-title":"Cureus"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/S2352-4642(20)30215-7","article-title":"Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: A multicentre observational study","volume":"4","author":"Davies","year":"2020","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1007\/s00431-023-05353-x","article-title":"NT-proBNP course during MIS-C post-COVID-19: An observational study","volume":"183","author":"Bichali","year":"2024","journal-title":"Eur. J. Pediatr."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jjcc.2009.03.005","article-title":"Impact of intravenous immunoglobulin infusion on longitudinal left ventricular performance in patients with acute Kawasaki disease of usual course","volume":"54","author":"Koteda","year":"2009","journal-title":"J. Cardiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.cca.2022.02.011","article-title":"Multisystem inflammatory syndrome in children: Inputs of BNP, NT-proBNP and Galectin-3","volume":"529","author":"Raynor","year":"2022","journal-title":"Clin. Chim. Acta"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1007\/s00246-023-03394-5","article-title":"Baseline echocardiography and laboratory findings in MIS-C and associations with clinical illness severity","volume":"45","author":"Beaver","year":"2024","journal-title":"Pediatr. Cardiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"667507","DOI":"10.3389\/fped.2021.667507","article-title":"Best practice recommendations for the diagnosis and management of children with Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS.; Multisystem Inflammatory Syn-drome in Children, MIS-C) in Switzerland","volume":"9","author":"Schlapbach","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1093\/jpids\/piaa161","article-title":"Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) antibody re-sponses in children With Multisystem Inflammatory Syndrome in Children (MIS-C) and mild and severe coro-navirus disease 2019 (COVID-19)","volume":"10","author":"Anderson","year":"2021","journal-title":"J. Pediatric Infect. Dis. Soc."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e144554","DOI":"10.1172\/JCI144554","article-title":"Similarities and differences between the immunopathogenesis of COVID-19\u2013related pediatric multisystem inflammatory syndrome and Kawasaki disease","volume":"131","author":"Anton","year":"2021","journal-title":"J. Clin. Investig."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"eabf7570","DOI":"10.1126\/sciimmunol.abf7570","article-title":"Deep immune profiling of MIS-C demonstrates marked but transient immune activation compared with adult and pediatric COVID-19","volume":"6","author":"Vella","year":"2021","journal-title":"Sci. Immunol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1038\/s41591-020-1054-6","article-title":"Peripheral immunophenotypes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection","volume":"26","author":"Carter","year":"2020","journal-title":"Nat. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.cell.2020.09.016","article-title":"The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19","volume":"183","author":"Consiglio","year":"2020","journal-title":"Cell."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"5942","DOI":"10.1172\/JCI141113","article-title":"Distinct clinical and immunological features of SARS-CoV-2-induced multisystem inflamma-tory syndrome in children","volume":"130","author":"Lee","year":"2020","journal-title":"J. Clin. Invest."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1111\/apa.17267","article-title":"Multisystem inflammatory syndrome in children: A review","volume":"113","author":"Benvenuto","year":"2024","journal-title":"Acta Paediatr."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1007\/s12098-008-0210-7","article-title":"Pulse steroid therapy","volume":"75","author":"Sinha","year":"2008","journal-title":"Indian J. Pediatr."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1038\/ncprheum0898","article-title":"Genomic and nongenomic effects of glucocorticoids","volume":"4","author":"Stahn","year":"2008","journal-title":"Nat. Clin. Pr. Rheumatol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.mce.2010.04.005","article-title":"The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights","volume":"335","author":"Coutinho","year":"2011","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12969-022-00771-x","article-title":"Similarities and differences between MIS-C and KD: A systematic review and meta-analysis","volume":"20","author":"Tong","year":"2022","journal-title":"Pediatr. Rheumatol."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Ferrara, G., Petrillo, M.G., Giani, T., Marrani, E., Filippeschi, C., Oranges, T., Simonini, G., and Cimaz, R. (2019). Clinical Use and Molecular Action of Corticosteroids in the Pediatric Age. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20020444"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1056\/NEJMra993360","article-title":"Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin","volume":"345","author":"Kazatchkine","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jaci.2010.10.030","article-title":"The IgG molecule as a biological immune response modifier: Mechanisms of action of intravenous immune serum globulin in autoimmune and inflammatory disorders","volume":"127","author":"Ballow","year":"2011","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/MOH.0000000000000609","article-title":"New insights into IVIg mechanisms and alternatives in autoimmune and inflammatory diseases","volume":"27","author":"Norris","year":"2020","journal-title":"Curr. Opin. Hematol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jpeds.2020.10.026","article-title":"Multisystem Inflammatory Syndrome in children: Survey of protocols for early hospital evaluation and management","volume":"229","author":"Dove","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e397","DOI":"10.1093\/cid\/ciaa1042","article-title":"Multi-inflammatory Syndrome in children related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain","volume":"72","author":"Moraleda","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"756083","DOI":"10.3389\/fped.2021.756083","article-title":"Comparison of Interleukin-6 plasma concentration in Multisystem Inflammatory Syndrome in children associated With SARS-CoV-2 and Pediatric Sepsis","volume":"9","author":"Diaz","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Kumar, N.P., Venkataraman, A., Nancy, A., Selvaraj, N., Moideen, K., Ahamed, S.F., Renji, R.M., Sasidaran, K., Kumar, S., and Periyakuppan, M. (2023). Immune profiles in Multisystem Inflammatory Syndrome in Children with cardiovascular abnormalities. Viruses, 15.","DOI":"10.3390\/v15112162"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Bartha-Tat\u00e1r, A., Sinkovits, G., Schnur, J., Mar\u00e1czi, V., D\u00e1vid, M., Zsigmond, B., Riman\u00f3czy, \u00c9., Szalay, B., Bir\u00f3, E., and Bek\u0151, G. (2024). Prognostic Value of baseline serum pro-inflammatory cytokines in severe Multisystem Inflammatory Syndrome in children. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237177"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"e2023063259","DOI":"10.1542\/peds.2023-063259","article-title":"Updated case definition of MIS-C and implications for clinical care","volume":"153","author":"Berbert","year":"2024","journal-title":"Pediatrics"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1002\/art.41616","article-title":"American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in children associated with SARS\u2013CoV-2 and hyperinflammation in pediatric COVID-19: Version 2","volume":"73","author":"Henderson","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/S0140-6736(20)31094-1","article-title":"Hyperinflammatory shock in children during COVID-19 pandemic","volume":"395","author":"Riphagen","year":"2020","journal-title":"Lancet"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/INF.0000000000003766","article-title":"Decreasing incidence of the Multisystem Inflammatory Syndrome in children over 3 pandemic waves","volume":"42","author":"Eleftheriou","year":"2022","journal-title":"Pediatr. Infect. Dis. J."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/9\/324\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:35:29Z","timestamp":1760034929000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/9\/324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":95,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcdd12090324"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12090324","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2025,8,25]]}}}