P2A349: Association Between Dopamine Use in MIS-C and Clinical Outcomes

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious illness temporally associated with SARS-CoV-2 presenting with features similar to incomplete Kawasaki disease and toxic shock syndrome, believed to be caused by a cytokine storm. For severe cases of MIS-C, vasoactives are often used for the treatment of vasoactive shock. Dopamine has potential immunomodulatory effects under septic shock that may lead to inhibition of IL-6 within monocytes/macrophages and endothelial cells. The cytokine IL-6 has been heavily implicated in the disease process of MIS-C. This preliminary study looks to assess if dopamine administration in patients admitted to our Pediatric Intensive Care Unit (PICU) in pediatric patients diagnosed with MIS-C is associated with improved clinical outcomes.

Methods: Charts were reviewed for all pediatric patients 21 years old and younger admitted to AMC’s PICU with a diagnosis of MIS-C requiring vasoactive therapy from March of 2020 to November of 2022. Demographic, clinical, laboratory data, treatment information, and outcome data was extracted into RedCAP ©, an online anonymized database. Chi square test, Fisher exact test, or Wilcoxon rank sum tests were used to study differences between those patients who had received dopamine versus those who had not.

Results: 21 patients were identified who were admitted to the PICU and required vasoactive therapy during the study period, 4 of whom were excluded for not meeting MIS-C criteria. 6 patients received dopamine during the length of their stay while 11 received other vasoactives. Baseline characteristics were similar between the groups except for the dopamine group consisting of only male patients (p = 0.035). Outcomes including mortality, readmission, or transfer to another center for escalating care showed no differences between the groups.

Conclusion: Our preliminary study suggests that despite theorized immunomodulatory effects of dopamine, there appear to be no significant differences in outcomes for patients with MIS-C who receive dopamine versus those who do not. While this preliminary study is limited by a relatively small sample size, it may be advised to select vasoactives other than dopamine in children with MIS-C in the setting of recent Surviving Sepsis guidelines. Further studies with larger sample sizes may be beneficial to better assess the role of dopamine in MIS-C.