tetano
Editor, Senior Moderator
Clin Infect Dis
. 2022 Apr 20;ciac303.
doi: 10.1093/cid/ciac303. Online ahead of print.
Multisystem inflammatory syndrome in adults (MIS-A): case finding through systematic review of electronic medical records
Michael Melgar[SUP] 1 [/SUP], Julia Haston[SUP] 1 2 [/SUP], Jennifer DeCuir[SUP] 1 2 [/SUP], Qi Cheng[SUP] 1 [/SUP], Kathryn E Arnold[SUP] 1 [/SUP], Lu Meng[SUP] 1 [/SUP], David J Murphy[SUP] 3 4 [/SUP], Elizabeth Overton[SUP] 4 [/SUP], Julie Hollberg[SUP] 4 5 [/SUP], Melissa Tobin-D'Angelo[SUP] 6 [/SUP], Pragna Patel[SUP] 1 [/SUP], Angela P Campbell[SUP] 1 [/SUP], Shana Godfred-Cato DO[SUP] 1 [/SUP], Ermias D Belay[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Multisystem inflammatory syndrome in adults (MIS-A) is a severe condition temporally associated with SARS-CoV-2 infection.
Methods: In this retrospective cohort study, we applied the U.S. Centers for Disease Control and Prevention (CDC) case definition to identify diagnosed and undiagnosed MIS-A cases among adults discharged April 2020-January 2021 from four Atlanta, Georgia hospitals affiliated with a single medical center. Non-MIS-A COVID-19 hospitalizations were identified using International Classification of Diseases, Tenth Revision encounter code U07.1. We calculated the ratio of MIS-A to COVID-19 hospitalizations, compared demographic characteristics of the two cohorts, and described clinical characteristics of MIS-A patients.
Results: We identified 11 MIS-A cases, none of which were diagnosed by the treatment team, and 5,755 COVID-19 hospitalizations (ratio 1: 523). Compared with patients with COVID-19, patients with MIS-A were more likely to be younger than 50 years (72.7% vs. 26.1%, p < 0.01) and to be non-Hispanic Black persons (81.8% vs. 50.0%, p = 0.04). Ten patients with MIS-A (90.9%) had at least one underlying medical condition. Two MIS-A patients (18.2%) had a previous episode of laboratory-confirmed COVID-19, occurring 37 and 55 days prior to admission. All MIS-A patients developed left ventricular systolic dysfunction. None had documented mucocutaneous involvement. All required intensive care, all received systemic corticosteroids, eight (72.7%) required mechanical ventilation, two (18.2%) required mechanical cardiovascular circulatory support, and none received intravenous immunoglobulin. Two (18.2%) died or were discharged to hospice.
Conclusions: MIS-A is severe but likely underrecognized complication of SARS-CoV-2 infection. Improved recognition of MIS-A is needed to quantify its burden and identify populations at highest risk.
Keywords: COVID-19; MIS-A; MIS-C; coronavirus; multisystem inflammatory syndrome in adults.
. 2022 Apr 20;ciac303.
doi: 10.1093/cid/ciac303. Online ahead of print.
Multisystem inflammatory syndrome in adults (MIS-A): case finding through systematic review of electronic medical records
Michael Melgar[SUP] 1 [/SUP], Julia Haston[SUP] 1 2 [/SUP], Jennifer DeCuir[SUP] 1 2 [/SUP], Qi Cheng[SUP] 1 [/SUP], Kathryn E Arnold[SUP] 1 [/SUP], Lu Meng[SUP] 1 [/SUP], David J Murphy[SUP] 3 4 [/SUP], Elizabeth Overton[SUP] 4 [/SUP], Julie Hollberg[SUP] 4 5 [/SUP], Melissa Tobin-D'Angelo[SUP] 6 [/SUP], Pragna Patel[SUP] 1 [/SUP], Angela P Campbell[SUP] 1 [/SUP], Shana Godfred-Cato DO[SUP] 1 [/SUP], Ermias D Belay[SUP] 1 [/SUP]
Affiliations
- PMID: 35442436
- DOI: 10.1093/cid/ciac303
Abstract
Background: Multisystem inflammatory syndrome in adults (MIS-A) is a severe condition temporally associated with SARS-CoV-2 infection.
Methods: In this retrospective cohort study, we applied the U.S. Centers for Disease Control and Prevention (CDC) case definition to identify diagnosed and undiagnosed MIS-A cases among adults discharged April 2020-January 2021 from four Atlanta, Georgia hospitals affiliated with a single medical center. Non-MIS-A COVID-19 hospitalizations were identified using International Classification of Diseases, Tenth Revision encounter code U07.1. We calculated the ratio of MIS-A to COVID-19 hospitalizations, compared demographic characteristics of the two cohorts, and described clinical characteristics of MIS-A patients.
Results: We identified 11 MIS-A cases, none of which were diagnosed by the treatment team, and 5,755 COVID-19 hospitalizations (ratio 1: 523). Compared with patients with COVID-19, patients with MIS-A were more likely to be younger than 50 years (72.7% vs. 26.1%, p < 0.01) and to be non-Hispanic Black persons (81.8% vs. 50.0%, p = 0.04). Ten patients with MIS-A (90.9%) had at least one underlying medical condition. Two MIS-A patients (18.2%) had a previous episode of laboratory-confirmed COVID-19, occurring 37 and 55 days prior to admission. All MIS-A patients developed left ventricular systolic dysfunction. None had documented mucocutaneous involvement. All required intensive care, all received systemic corticosteroids, eight (72.7%) required mechanical ventilation, two (18.2%) required mechanical cardiovascular circulatory support, and none received intravenous immunoglobulin. Two (18.2%) died or were discharged to hospice.
Conclusions: MIS-A is severe but likely underrecognized complication of SARS-CoV-2 infection. Improved recognition of MIS-A is needed to quantify its burden and identify populations at highest risk.
Keywords: COVID-19; MIS-A; MIS-C; coronavirus; multisystem inflammatory syndrome in adults.