A systematic review and meta-analysis on the effectiveness of intravenous immunoglobulin plus corticosteroids vs immunoglobulin alone as an initial therapy of COVID-19 associated Multisystem Inflammatory Syndrome in children (MIS-C)
Bibliographic record
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) is the most severe pediatric disease associated with COVID- 19 for which the optimal therapeutic strategy remains unknown. There have been studies that aim to describe treatment outcomes but have conflicting findings. Evidence is urgently needed to support treatment decisions for MIS-C. Objective: This study aims to compare the effectiveness of intravenous immunoglobulins (IVIG) plus corticosteroids versus IVIG alone as initial therapy in MIS-C, in terms of decrease in left ventricular dysfunction, decrease in inotropic support, reduced need for adjunctive immunomodulatory treatment, favorable fever course, decrease in mechanical ventilator use, decrease in admission to the pediatric intensive care unit, and decrease in coronary artery aneurysm. Methodology: Published articles reporting MIS-C treatment outcomes were searched through various databases. A structured data extraction was employed and risk of bias was assessed with Newcastle-Ottawa Scale. Corticosteroid effects were reported as pooled odds ratio and forest plots were generated for each outcome. Results: The effect on the components of hemodynamic support showed no significant difference between the two treatment groups: left ventricular dysfunction (P-value= 0.86), inotrope use (P-value = 0.65), mechanical ventilator use (P-value = 0.21), and admission at the PICU (P-value = 0.87). However, initial treatment with IVIG plus corticosteroids, was associated with a more favorable fever course (P-value = < 0.02), less use of adjunctive immunomodulatory therapy (P-value = < 0.00001), and less incidence of coronary artery aneurysm (P-value = < 0.04). Conclusion: Initial treatment with IVIG plus glucocorticoids was associated with a more favorable fever course, less use of adjunctive immunomodulatory therapy, and less incidence of coronary artery aneurysm than IVIG alone.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.026 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.022 | 0.038 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".