Immune globulin treatment recovers LV systolic function in children with COVID-19
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Treatment with immune globulin led to left ventricular systolic function recovery in children with acute cardiac decompensation from inflammation associated with COVID-19, according to a study published in Circulation.
“This inflammatory syndrome shares similarities with the well-known Kawasaki disease, but there are also important differences that should be known,” Damien Bonnet, MD, PhD, head of the French reference center for complex and rare cardiac pediatric diseases at Hôpital Necker-Enfants Malades in Paris, told Healio. “Outcomes are good in the majority of children. Treatment has been borrowed from the Kawasaki disease’s treatment. Collective effort to improve management of these kids is necessary.”
Zahra Belhadjer, MD, of Necker Enfants Malades Hospital in Paris, and colleagues conducted this study after noticing that many children were hospitalized in ICUs for acute LV dysfunction or cardiogenic shock while in a multisystem inflammatory state, according to the study. A large number of these children tested positive for COVID-19.
To assess this further, researchers analyzed data from 35 children (median age, 10 years; 51% boys) with cardiogenic shock of acute LV systolic dysfunction associated with multisystem inflammatory who were admitted to hospitals in France and Switzerland from March 22 to April 30. Children had a fever, defined as greater than 38.5°C, and were in an inflammatory state, defined as a C-reactive protein greater than 100 mg/mL. All children were tested for COVID-19.
Of these children, 28% had comorbidities including overweight (17%) and asthma (8.5%). Gastrointestinal symptoms were observed in 83% of patients including vomiting, abdominal pain or diarrhea. Ten children had LV ejection fraction below 30%. Eighty percent of children with cardiogenic shock required IV inotropic drugs, and 28% were treated with extracorporeal membrane oxygenation.
All patients had a severe inflammatory state, which was suggestive of macrophage activation via a median D-dimer of 5,284 ng/mL, in addition to cytokine storm with a median interleukin-6 level of 135 pg/mL.
The majority of children (88%) tested positive for COVID-19. All patients were treated with IV immune globulin, with 25 patients receiving it as first-line treatment. One-third of children were also treated with adjunctive steroid therapy.
LV function was completely recovered in 71% of children. There were no deaths, and all patients who received extracorporeal membrane oxygenation successfully weaned off.
“Many issues still need to be address, some of which are urgent: Gather information, identify risk factors for severe forms, identify if children have any sequelae of this multisystem inflammatory syndrome,” Bonnet said in an interview. “Others that will be important issues in the future are mechanisms of disease, genetic or ethnic susceptibility and therapeutic trials with specific medications.”
For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio.
For more information:
Damien Bonnet, MD, PhD, can be reached at damien.bonnett@aphp.fr.
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