Association of Early Steroid Administration With Outcomes of Children Hospitalized for COVID-19 Without Multisystem Inflammatory Syndrome in Children

Authors

Sandeep Tripathi
Meghana Nadiger
Jeremy S McGarvey
Aaron A Harthan
Monica Lombardo
Varsha P Gharpure
Nicholas Perkins
Kathleen Chiotos
Imran A Sayed
Erica C Bjornstad
Utpal S Bhalala
Umamaheswara Raju
Aaron S Miller
Heda Dapul
Vicki Montgomery
Karen Boman
Grace M Arteaga
Vikas Bansal
Neha Deo
Aysun Tekin
Ognjen Gajic
Vishakha K Kumar
Rahul Kashyap
Allan J Walkey

Publication Date

10-3-2022

Journal

JAMA Pediatrics

DOI

10.1001/jamapediatrics.2022.3611

PMID

36190706

PMCID

PMC9531079

PubMedCentral® Posted Date

10-3-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Abstract

IMPORTANCE: There is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).

OBJECTIVE: To determine whether the use of steroids within 2 days of admission for non-MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data retrospectively for children (<18 >years) who required hospitalization for non-MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.

EXPOSURE: Administration of steroids within 2 days of admission.

MAIN OUTCOMES AND MEASURES: Length of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.

RESULTS: A total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score-matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.

CONCLUSIONS AND RELEVANCE: Steroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.