In new study, patients with MIS-A had broader organ involvement than previously noted
A small cohort of patients at a Tennessee hospital who met the criteria for multisystem inflammatory syndrome in adults experienced broader organ involvement and were less ill compared with patients in a previous report, researchers said.
Multisystem inflammatory syndrome in adults (MIS-A) is a severe complication of SARS-CoV-2 infection that resembles a similar condition in children called MIS-C. MIS-A was first documented last October in an MMWR report.
For the new study, Giovanni E. Davogustto, MD, an instructor in medicine at Vanderbilt University Medical Center, and colleagues identified adults aged 21 years and older from March 1 to Sept. 30, 2020, who were hospitalized between 14 and 84 days after testing positive for SARS-CoV-2, or 15 days before or after being classified at risk for MIS-A from serological test results.
A total of 7,196 patients were identified. Of those, 839 patients (11.7%) were admitted during the study period. Of those, 156 (11.7%) were classified for being at risk for MIS-A, including 15 who met the risk criteria for the syndrome.
The 15 patients had a median age of 55.8 years (range, 21.2-96.9 years) and a majority were men (53.3%) and white (58.2%).
Those with MIS-A were younger — median age, 45.1 years; range 21.3 to 84 years — and more likely to have evidence of SARS-CoV-2 infection documented by serological testing (nine patients; 60%).
The majority of patients with MIS-A (nine patients; 60%) had acute COVID-19 symptoms, and three (20%) required admission for acute COVID-19 before being admitted for MIS-A. Those who were previously admitted for COVID-19 and then admitted again for MIS-A had a median interval between admissions of 23 days (range, 16-24.5 days).
Of those admitted for MIS-A, three patients (20%) had MIS-A as a clinical diagnosis, four (26.7%) received immunosuppressive therapy, seven (46.6%) received antibiotic therapy and none died.
The median number of organ systems involved among all patients was four (range, 2-4.5 systems). The gastrointestinal (12 patients), hematologic (10), and kidneys (10) were the most commonly affected.
Davogustto and colleagues said most patients meeting the criteria for MIS-A were not identified by the primary clinical team.
“Our data likely underestimate the incidence of MIS-A because many patients with COVID-19-related admissions did not have routine comprehensive clinical and laboratory assessments to screen for this syndrome,” they wrote.
Perspective
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The most salient observation of this study is most adults meeting the criteria for MIS-A were not prospectively identified by their treatment teams at the time of admission. In total, 9.6% of adults (15 of 156 deemed at risk for COVID-19) met the criteria for MIS-A. The number, conceivably, may have been higher because 13 were excluded for not having inflammatory biomarkers assessed. Twenty percent of those eventually diagnosed with MIS-A were admitted for acute COVID-19, underscoring the risk of these dangerous postinfection sequela, even in those with relatively mild infection. Once suffering from MIS-A, less than half required ICU admission, although a substantial proportion exhibited multiorgan dysfunction, most commonly gastrointestinal, hematologic, renal and cardiovascular. This is reminiscent of past studies in MIS-C. Happily, all patients survived, and the length of stay was not significantly prolonged. All told, we will need active surveillance to ascertain MIS-A incidence in real time.
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