Multisystem Inflammatory Syndrome in Adults: Case Finding Through Systematic Review of Electronic Medical Records. (20th April 2022)

• Record Type: Journal Article
• Authors: Melgar, Michael; Haston, Julia; DeCuir, Jennifer; Cheng, Qi; Arnold, Kathryn E; Meng, Lu; Murphy, David J; Overton, Elizabeth; Hollberg, Julie; Tobin-D'Angelo, Melissa; Patel, Pragna; Campbell, Angela P; Godfred-Cato, Shana; Belay, Ermias D
• Is Part Of: Clinical infectious diseases. Volume 75:Number 11(2022)
• Page Start: 1903
• Page End: 1911
• Publication Date: 2022-04-20
• Subjects: COVID-19 -- coronavirus -- MIS-A -- MIS-C -- multisystem inflammatory syndrome in adults; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciac303
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Multisystem inflammatory syndrome in adults (MIS-A) is a severe condition temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods: In this retrospective cohort study, we applied the US Centers for Disease Control and Prevention (CDC) case definition to identify diagnosed and undiagnosed MIS-A cases among adults discharged during April 2020–January 2021 from 4 Atlanta, Georgia hospitals affiliated with a single medical center. Non–MIS-A coronavirus disease 2019 (COVID-19) hospitalizations were identified using International Classification of Diseases, Tenth Revision, Clinical Modification encounter code U07.1. We calculated the ratio of MIS-A to COVID-19 hospitalizations, compared demographic characteristics of the 2 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 5755 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 < .01) and to be non-Hispanic Black (81.8% vs 50.0%, P = .04). Ten patients with MIS-A (90.9%) had at least 1 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, 8 (72.7%) required mechanical ventilation, 2 (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 a 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. Abstract : At a Georgia medical center, we identified 1 case of multisystem inflammatory syndrome in adults (MIS-A) for every 523 adult COVID-19 hospitalizations. Adults aged <50 years and non-Hispanic Black adults were overrepresented among MIS-A patients. MIS-A is rare but likely underrecognized.