The Predictive value of Serum IL-6 in Pediatric Critically ill Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19

Abstract

ultisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection is uncommon, but it is life-threatening, frequently presenting as rapid-onset severe organ failure. It is thought to be driven by a post-viral dysregulated immune response, although the underlying pathophysiological processes are still poorly understood. The clinical features of MIS-C have led to the assumption that the inflammation is exceptionally high, so-called cytokine storm; thus, empirical immunomodulation is the current therapy. However, there is no clear definition for cytokine storm. In theory, it refers to a harmful level of cytokines. However, as pointed out by some authors' the term is misleading because it falsely gives some impression to be related to a different entity, the cytokine release syndrome (CRS). CRS is a severe systemic inflammatory response caused by cytokines released by infused Chimeric antigen receptor (CAR)-modified T cells (CAR-Ts), where IL-6 is one of the main drivers. Interleukin-6 (IL-6) is a pleiotropic cytokine with a pivotal role in the inflammatory and anti-inflammatory pathways. It has been previously studied in many conditions characterized by local or systemic insults, like bacterial and viral sepsis, and autoimmune diseases, like juvenile rheumatoid arthritis (JRA).