Comparative Effectiveness of Intravenous Immunoglobulin vs Steroids in the Treatment of Pediatric Acute (non-COVID) Myocarditis.
Academic Article
Overview
abstract
OBJECTIVES: To describe the epidemiology of acute, non-COVID-19 myocarditis in hospitalized children and to evaluate the association of administration of intravenous immunoglobulin (IVIg) and/or steroids with hospital mortality. STUDY DESIGN: We conducted a retrospective cohort study using the Pediatric Health Information System (PHIS) database. Children (ages 0-18 years) coded for myocarditis from 2012-2022 were included. Patients missing pharmacy data or those with a diagnosis of COVID-19 were excluded. Data included demographics, complex chronic conditions, medications, and clinical course. Patients were divided into 4 treatment categories: (1) no IVIg or steroids, (2) steroids, (3) IVIg, and (4) both IVIg and steroids. RESULTS: 2294 children were included. Treatment groups were (1 - none) 8% (189/2294); (2 - steroids) 20% (450/2294); (3 - IVIg) 25% (578/2294); and (4 - IVIg and steroids) 47% (1077/2294). In-hospital mortality was 8%. The proportion of patients who received IVIg alone decreased significantly over the study period (tau= -0.527, p=0.03). After adjusting for sex, race, hospital region, age at admission, length of stay, need for intensive care, presence of a complex chronic condition, and use of anti-arrhythmic medication, the receipt of IVIg alone (OR 0.24, 95% CI 0.13-0.42) or the combination of IVIg and steroids (OR 0.60, 95% CI 0.42-0.87) was independently associated with decreased mortality compared with steroid use alone. These associations were also seen in a sub-group of children with acute fulminant myocarditis. CONCLUSIONS: In-hospital mortality from acute myocarditis in children remains important. Although IVIg use has decreased over time, IVIg with or without steroids is associated with improved survival.
