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1.
J Immunother Cancer ; 9(3)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33753569

RESUMEN

BACKGROUND: Patients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study. METHODS: In a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets. RESULTS: We evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p<0.01), recovering in survivors to pre-COVID-19 levels. Patients in poorer risk categories for each index except the PLR exhibited higher mortality rates (p<0.001) and shorter median overall survival in the training and validation sets (p<0.01). Multivariable analyses revealed the OIS to be most independently predictive of survival (validation set HR 2.48, 95% CI 1.47 to 4.20, p=0.001; adjusted concordance index score 0.611). CONCLUSIONS: Systemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used as a bedside predictor of adverse outcome. Lymphocytopenia and hypoalbuminemia as computed by the OIS are independently predictive of severe COVID-19, supporting their use for risk stratification. Reversal of the COVID-19-induced proinflammatory state is a putative therapeutic strategy in patients with cancer.


Asunto(s)
/tratamiento farmacológico , Neoplasias/virología , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Adulto , Anciano , Anciano de 80 o más Años , Recuento de Células Sanguíneas , /mortalidad , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neoplasias/epidemiología , Pronóstico , Síndrome de Respuesta Inflamatoria Sistémica/virología , Adulto Joven
2.
Front Immunol ; 12: 648546, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33763085

RESUMEN

Multisystem Inflammatory Syndrome in children (MIS-C) is a rare but devastating complication of coronavirus disease 19 (COVID-19). The development of prognostic biomarkers and more importantly the implementation of new treatment modalities would have a significant impact in clinical practice regarding the outcome of MIS-C. Vitamin D could be a potential candidate. In this mini review we analyze the immunomodulatory role of vitamin D in viral infections and specifically in COVID-19. We also examine the current literature regarding the association of vitamin D with MIS-C and Kawasaki disease. The vitamin D was evaluated not only as a biomarker but also as a nutritional supplement. We concluded that vitamin D levels could be valuable in predicting severe forms of MIS-C and correction of abnormal levels in severe MIS-C may influences its evolution. 25-hydroxyvitamin D3 [25(OH)D3] supplementation raising serum [25(OH)D] concentrations potentially have a favorable effect in reducing the severity of MIS-C in certain circumstances. Further studies are needed to confirm these results.


Asunto(s)
/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Vitamina D/administración & dosificación , Animales , /tratamiento farmacológico , /virología , Niño , Humanos , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Vitamina D/sangre
3.
Medicine (Baltimore) ; 100(13): e24951, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787581

RESUMEN

ABSTRACT: Hypertension is associated with chronic inflammation in the tissues and organs that are involved in the regulation of arterial pressure, such as kidneys and blood vessels. Periodontal disease affects systemic inflammatory markers, leading to endothelial dysfunction, atherosclerotic plaque instability, dyslipidaemia, and insulin resistance. These conditions can also cause an increase in the blood pressure. Nonsurgical periodontal therapies, such as scaling and root planning, can affect systemic markers of inflammation. We evaluated the effect of scaling and root planning on serum levels of inflammation biomarkers in hypertensive patients. The sample consisted of 19 hypertensive patients with Periodontitis. The patients underwent laboratory tests that included glycaemia, cholesterol, triglycerides and blood count. Blood pressure was measured before periodontal therapy, and the second blood pressure recording was obtained at the re-evaluation appointment. Quantification of peripheral blood cytokines was performed using the Milliplex Inflammation Human Cytokine kit (Interleukin 1-ß, Interleukin-4, Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-12 P70, Interleukin-17A, vascular endothelial growth factor and tumor necrosis factor-alpha). All cytokine levels decreased from the initial examination to reassessment. Cytokines that reflected a statistically significant difference included Interleukin-1ß and endothelial vascular growth factor (P = .04 and P = .004). Hypertensive patients with periodontitis undergoing non-surgical periodontal treatment exhibited a decrease in proinflammatory cytokine levels. Non-surgical periodontal treatment decreases the levels of systemic proinflammatory cytokines in controlled hypertensive patients.


Asunto(s)
Raspado Dental , Hipertensión/complicaciones , Periodontitis/terapia , Aplanamiento de la Raíz , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Biomarcadores/sangre , Recuento de Células Sanguíneas , Glucemia/análisis , Presión Sanguínea , Colesterol/sangre , Citocinas/sangre , Femenino , Humanos , Hipertensión/sangre , Masculino , Persona de Mediana Edad , Periodontitis/sangre , Periodontitis/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Resultado del Tratamiento , Triglicéridos/sangre
5.
Eur Rev Med Pharmacol Sci ; 25(2): 1146-1157, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33577071

RESUMEN

OBJECTIVE: Many studies have been published recently on the characteristics of the clinical manifestations of COVID-19 in children. The quality scores of literature are different, and the incidence of clinical manifestations and laboratory tests results vary greatly. Therefore, a systematic retrospective meta-analysis is needed to determine the incidence of the clinical manifestations of COVID-19 in children. MATERIALS AND METHODS: Data from databases, such as PubMed, Web of science, EMBASE, Johns Hopkins University, and Chinese databases were analysed from January 31, 2020 to October 20, 2020. High-quality articles were selected for analysis based on a quality standard score. A meta-analysis of random effects was used to determine the prevalence of comorbidities and subgroup meta-analysis to examine the changes in the estimated prevalence in different subgroups. RESULTS: Seventy-one articles involving 11,671 children were included in the study. The incidence of fever, respiratory symptoms, gastrointestinal symptoms, asymptomatic patients, nervous system symptoms, and chest tightness was 55.8%, 56.8%, 14.4%, 21.1%, 6.7%, and 6.1%, respectively. The incidence of multisystem inflammatory syndrome was 6.2%. Laboratory examination results showed that lymphocytes decreased in 12% and leukocytes decreased in 8.8% of patients, whereas white blood cells increased in 7.8% of patients. Imaging showed abnormalities in 66.5%, and ground-glass opacities were observed in 36.9% patients. Epidemiological history was present in 85.2% cases; severe disease rate was 3.33%. The mortality rate was 0.28%. CONCLUSIONS: The clinical symptoms of COVID-19 in children are mild, and laboratory indicators and imaging manifestations are atypical. While screening children for COVID-19, in addition to assessing patients for symptoms as the first step of screening, the epidemiological history of patients should be obtained.


Asunto(s)
/sangre , /diagnóstico por imagen , /complicaciones , Niño , Preescolar , Humanos , Estudios Retrospectivos , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico por imagen , Síndrome de Respuesta Inflamatoria Sistémica/etiología
6.
Allergy Asthma Proc ; 42(1): 8-15, 2021 01 03.
Artículo en Inglés | MEDLINE | ID: mdl-33404385

RESUMEN

Background: Since its initial description in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has rapidly progressed into a worldwide pandemic, which has affected millions of lives. Unlike the disease in adults, the vast majority of children with COVID-19 have mild symptoms and are largely spared from severe respiratory disease. However, there are children who have significant respiratory disease, and some may develop a hyperinflammatory response similar to that seen in adults with COVID-19 and in children with Kawasaki disease (KD), which has been termed multisystem inflammatory syndrome in children (MIS-C). Objective: The purpose of this report was to examine the current evidence that supports the etiopathogenesis of COVID-19 in children and the relationship of COVID-19 with KD and MIS-C as a basis for a better understanding of the clinical course, diagnosis, and management of these clinically perplexing conditions. Results: The pathogenesis of COVID-19 is carried out in two distinct but overlapping phases of COVID-19: the first triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and the second by the host immune response. Children with KD have fewer of the previously described COVID-19-associated KD features with less prominent acute respiratory distress syndrome and shock than children with MIS-C. Conclusion: COVID-19 in adults usually includes severe respiratory symptoms and pathology, with a high mortality. It has become apparent that children are infected as easily as adults but are more often asymptomatic and have milder disease because of their immature immune systems. Although children are largely spared from severe respiratory disease, they can present with a SARS-CoV-2-associated MIS-C similar to KD.


Asunto(s)
/diagnóstico , Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/etiología , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Factores de Edad , Niño , Humanos , Síndrome de Respuesta Inflamatoria Sistémica/terapia
7.
Paediatr Drugs ; 23(2): 119-129, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33479801

RESUMEN

Although data on the incidence and severity of new coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection showed more significant disease among adults and the elderly, a clinical manifestation characterized by a multisystem inflammatory syndrome was described in children (MIS-C). It was initially thought to be specific to children, but recent reports have shown that it can also occur in adults. MIS-C is characterized by a number of multisystemic manifestations resembling other known previously described illnesses, mainly Kawasaki disease, especially in cases with shock, toxic shock syndrome, and macrophage activation syndrome. Available literature shows that our knowledge of MIS-C is largely incomplete. Its development in strict relation with SARS-CoV-2 infection seems documented and, in most cases, can be considered a post-infectious manifestation secondary to an abnormal immune response for some aspects, similar to that seen in adults several days after SARS-CoV-2 infection. However, in a minority of cases, a clinical picture with symptoms fulfilling criteria for MIS-C diagnosis develops during the acute phase of SARS-CoV-2 infection. It is highly likely that the criteria currently used to diagnose MIS-C are too broad, meaning that children with different diseases are included. As clarity on the pathogenesis of MIS-C is lacking, different therapeutic approaches have been used, but no specific therapy is currently available. Further studies are urgently needed to improve our definition of MIS-C, to define the real impact on child health, and to elucidate the best clinical and therapeutic approach and true prognosis.


Asunto(s)
/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/etiología , /etiología , Niño , Humanos , Síndrome Mucocutáneo Linfonodular/etiología , Síndrome Mucocutáneo Linfonodular/terapia , Síndrome de Respuesta Inflamatoria Sistémica/terapia
8.
J Clin Invest ; 131(6)2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33497356

RESUMEN

Multisystem inflammatory syndrome associated with the SARS-CoV-2 pandemic has recently been described in children (MIS-C), partially overlapping with Kawasaki disease (KD). We hypothesized that (a) MIS-C and prepandemic KD cytokine profiles may be unique and justify the clinical differences observed, and (b) SARS-CoV-2-specific immune complexes (ICs) may explain the immunopathology of MIS-C. Seventy-four children were included: 14 with MIS-C, 9 patients positive for SARS-CoV-2 by PCR without MIS-C (COVID), 14 with prepandemic KD, and 37 healthy controls (HCs). Thirty-four circulating cytokines were quantified in pretreatment serum or plasma samples and the presence of circulating SARS-CoV-2 ICs was evaluated in MIS-C patients. Compared with HCs, the MIS-C and KD groups showed most cytokines to be significantly elevated, with IFN-γ-induced response markers (including IFN-γ, IL-18, and IP-10) and inflammatory monocyte activation markers (including MCP-1, IL-1α, and IL-1RA) being the main triggers of inflammation. In linear discriminant analysis, MIS-C and KD profiles overlapped; however, a subgroup of MIS-C patients (MIS-Cplus) differentiated from the remaining MIS-C patients in IFN-γ, IL-18, GM-CSF, RANTES, IP-10, IL-1α, and SDF-1 and incipient signs of macrophage activation syndrome. Circulating SARS-CoV-2 ICs were not detected in MIS-C patients. Our findings suggest a major role for IFN-γ in the pathogenesis of MIS-C, which may be relevant for therapeutic management.


Asunto(s)
/etiología , Citocinas/sangre , Síndrome Mucocutáneo Linfonodular/etiología , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Adolescente , Anticuerpos Antivirales/sangre , Complejo Antígeno-Anticuerpo/sangre , Antígenos Virales/sangre , /virología , Estudios de Casos y Controles , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Lactante , Interferón gamma/sangre , Masculino , Modelos Inmunológicos , Síndrome Mucocutáneo Linfonodular/inmunología , Pandemias , /inmunología , Síndrome de Respuesta Inflamatoria Sistémica/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/virología
10.
Nat Med ; 27(1): 28-33, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33442016

RESUMEN

COVID-19, caused by SARS-CoV-2 infection, is mild to moderate in the majority of previously healthy individuals, but can cause life-threatening disease or persistent debilitating symptoms in some cases. The most important determinant of disease severity is age, with individuals over 65 years having the greatest risk of requiring intensive care, and men are more susceptible than women. In contrast to other respiratory viral infections, young children seem to be less severely affected. It is now clear that mild to severe acute infection is not the only outcome of COVID-19, and long-lasting symptoms are also possible. In contrast to severe acute COVID-19, such 'long COVID' is seemingly more likely in women than in men. Also, postinfectious hyperinflammatory disease has been described as an additional outcome after SARS-CoV-2 infection. Here I discuss our current understanding of the immunological determinants of COVID-19 disease presentation and severity and relate this to known immune-system differences between young and old people and between men and women, and other factors associated with different disease presentations and severity.


Asunto(s)
/inmunología , /fisiología , Inmunidad Adaptativa , Adulto , Factores de Edad , Anciano , /epidemiología , Niño , Femenino , Humanos , Inmunidad Innata , Síndromes de Inmunodeficiencia/inducido químicamente , Síndromes de Inmunodeficiencia/inmunología , Síndromes de Inmunodeficiencia/virología , Masculino , Índice de Severidad de la Enfermedad , Factores Sexuales , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Internalización del Virus
12.
Clin Interv Aging ; 15: 2331-2340, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33324045

RESUMEN

Purpose: Knowledge regarding the systemic inflammatory response syndrome (SIRS) associated with emergent large vessel occlusion (ELVO) is still insufficient. We aimed to investigate the occurrence rate, predictors, and clinical outcomes of SIRS in patients with ELVO after endovascular treatment (EVT). Patients and Methods: We retrospectively collected EVT data of patients with ELVO from July 2015 to August 2019 in our center. SIRS in the absence of infection was recorded in detail. A favorable outcome was defined as obtaining a 90-day modified Rankin Scale (mRS) score ≤2. Results: Among the 256 patients who received EVT, 91 (35.5%) developed SIRS. The patients who developed SIRS had a reduced favorable outcome (OR 4.112 [95% CI 1.705 to 9.920]; p=0.002) and higher mortality (OR 25.336 [95% CI 8.578 to 74.835]; p<0.001) at 90 days. A greater SIRS burden was positively correlated with the NIHSS scores at discharge and mRS scores at 90 days (r=0.265, p=0.011; r=0.245, p=0.019). The development of SIRS was associated with neutrophilic leukocytosis, hyperglycemia, higher NIHSS scores at admission, and worse collateral circulation. Conclusion: The patients with SIRS had higher odds of poor functional outcomes and higher mortality at 90 days in the EVT-treatment setting. The severity of the inflammatory response was positively correlated with the clinical outcomes of the patients. Clinically, SIRS was associated with neutrophilic leukocytosis, hyperglycemia, baseline stroke severity, and worse collateral circulation.


Asunto(s)
Procedimientos Endovasculares/efectos adversos , Hemorragias Intracraneales/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Anciano , Circulación Colateral/fisiología , Femenino , Humanos , Hemorragias Intracraneales/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Factores de Tiempo , Resultado del Tratamiento
13.
Cell ; 183(4): 968-981.e7, 2020 11 12.
Artículo en Inglés | MEDLINE | ID: mdl-32966765

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4-6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology. We apply systems-level analyses of blood immune cells, cytokines, and autoantibodies in healthy children, children with Kawasaki disease enrolled prior to COVID-19, children infected with SARS-CoV-2, and children presenting with MIS-C. We find that the inflammatory response in MIS-C differs from the cytokine storm of severe acute COVID-19, shares several features with Kawasaki disease, but also differs from this condition with respect to T cell subsets, interleukin (IL)-17A, and biomarkers associated with arterial damage. Finally, autoantibody profiling suggests multiple autoantibodies that could be involved in the pathogenesis of MIS-C.


Asunto(s)
Infecciones por Coronavirus/patología , Neumonía Viral/patología , Síndrome de Respuesta Inflamatoria Sistémica/patología , Autoanticuerpos/sangre , Betacoronavirus/aislamiento & purificación , Niño , Preescolar , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/virología , Citocinas/metabolismo , Femenino , Humanos , Inmunidad Humoral , Lactante , Masculino , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/inmunología , Síndrome Mucocutáneo Linfonodular/patología , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/virología , Análisis de Componente Principal , Proteoma/análisis , Índice de Severidad de la Enfermedad , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/inmunología , Subgrupos de Linfocitos T/citología , Subgrupos de Linfocitos T/inmunología , Subgrupos de Linfocitos T/metabolismo
14.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-32933913

RESUMEN

The COVID-19 pandemic has created an unprecedented disease burden worldwide, affecting patients of all ages. Recently, there has been a rise in a new inflammatory condition termed paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PMIS-TS). We are yet to understand significant risk factors, disease progression and prognosis in children affected. We describe a case of a 9-year-old boy who tested positive concurrently for the SARS-CoV-2 virus 4 weeks apart. He presented with a 2-day history of fever, abdominal pain, headache and diarrhoea. Initial investigations supported PMIS-TS and he went on to develop atypical Kawasaki disease. With no results to differentiate between his positive results, we question whether he remained positive throughout or recovered with reactivation of the virus. There are reports of reactivation in adults but none in children. There are also no reports of children remaining positive for such a prolonged period, which raises public health concerns.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Síndrome Mucocutáneo Linfonodular/etiología , Neumonía Viral/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Niño , Humanos , Masculino , Pandemias
15.
Nurs Child Young People ; 32(5): 13-16, 2020 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-32776761

RESUMEN

Little is understood about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the COVID-19 pandemic. Furthermore, there is limited literature available and few case studies exploring the observations of colleagues involved in managing patients with COVID-19. Children represent a small sample of the confirmed cases of COVID-19 in the UK but the reasons for this are relatively unknown. Most children are asymptomatic or exhibit mild symptoms from COVID-19 infection. However, a small number have been identified who develop a significant systemic inflammatory response, referred to as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). PIMS-TS involves persistent fever and organ dysfunction. PIMS-TS can also share clinical features with other conditions including toxic shock syndrome, septic shock and Kawasaki disease. This article presents a case study to explore the resuscitative care provided to a ten-year-old child with suspected PIMS-TS.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Resucitación , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Niño , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Pandemias , Neumonía Viral/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/etiología
20.
Buenos Aires; IECS; 18 ago. 2020.
No convencional en Español | LILACS, BRISA/RedTESA | ID: biblio-1119347

RESUMEN

CONTEXTO CLÍNICO: La enfermedad por el Coronavirus 2019 (COVID-19), por su sigla en inglés Coronavirus Disease 2019) es una enfermedad respiratoria de humanos por un nuevo Coronovirus identificado con la sigla SARS-CoV-2. TECNOLOGÍA: Los glucocorticoides (GCS) son una familia de medicamentos antiinflamatorios e inmunomodulares que se utilizan en el tratamiento de diversas patologías cuyo principal componente etiopatogénico es la inflamación. Dentro de los mecanismos de acción propuestos se encuentran> inhibición de citoquinas inflamatorias (IL-1 y IL-2), inhibición de la migración de lecucocitaria, inhibición de la desgranulación de mastocitos, depleción linfocitaria (principalmentelinfocitos T), incremento de citoquinas anti-inflamatorias (IL-10). Dentro de las alternativas para la administración sistémica se pueden mencionar a la hidrocortisona, dexametasona, betametasona, predinisona, prednisolona, metilprednisolona y deflazacort. Todos ellos difieren principalmente en el grado de actividad mineralocorticorticoide y vida media. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia y seguridad de los tratamientos propuestos del síndrome inflamatorio multisistémico asociado a COVID-19 en pacientes pediátricos. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y recomendaciones de diferentes organizaciones de salud. RESULTADOS: No se encontró evidencia acerca de la efectividad comparativa (ya sea contra medidas de soporte/placebo o entre diversos tratamientos activos entre si) del tratamiento con inmunoglobulinas, corticoides o agentes biológicos inmunomoduladores en pacientes pediátricos con síndrome de inflamación multisistémica asociado a COVID-19. Se incluyeron estudios obervacionales y o recomendaciones, acerca del tratamiento de esta patología en niños, niñas y adolescentes. Solo se encontró un ensayo clínico en curso para evaluar el tratamiento con células del estroma mesenquimal a los que se les administrará corticoides (hidrocortisona) y difenhidramina en esta población. Se describe a continuación información proveniente de cuatro series de casos y se incluyen cinco guías de práctica clínica donde mencionan las alternativas terapéuticas en el tratamiento del SIMP. CONCLUSIONES: Evidencia de muy baja calidad proveniente de series de casos no permite determinar la eficacia ni la seguridad del tratamiento con inmunoglobulinas, corticoides y agentes biológicos inmunomoduladores en pacientes pediátricos con síndrome inflamatorio multisistémico asociado a COVID-19.


Asunto(s)
Humanos , Infecciones por Coronavirus/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Betacoronavirus/efectos de los fármacos , Glucocorticoides/uso terapéutico , Evaluación de la Tecnología Biomédica , Evaluación en Salud , Análisis Costo-Beneficio
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