Enigma of COVID-19: is “multisystem inflammatory syndrome in adults” (MIS-A) predictable?

Abstract

Background Severe inflammation and one or more extrapulmonary organ dysfunctions have been reported and this clinical picture is defined as "multisystem inflammatory syndrome in adults" (MIS-A) in severe coronavirus disease-2019 (COVID-19). We aimed to determine the effect of LDH/lymphocyte ratio (LLR) on the development of MIS-A. Methods The data of 2333 patients were retrospectively analyzed. Results MIS-A rate was found to be 9.9% and MIS-A related mortality was 35.3%. LRR level above 0.24 was found to predict MIS-A development with 70% sensitivity and 65.2% specificity. The risk of MIS-A development was found to be 3.64 times higher in those with LRR levels above 0.24 compared to those with 0.24 and below. In patients with MIS-A, LRR level above 0.32 predicts mortality with 78% sensitivity and 70% specificity. Conclusions Early detection of MIS-A with high sensitivity and specificity in a practical ratio is very important in terms new studies.

Fatal multisystem inflammatory syndrome in a 78-year-old adult after severe COVID-19 pneumonia during 2022 Omicron variant epidemic in Shanghai, China

“…First identified in April 2020, MIS seemed to happen more commonly to children. However, recent studies on MIS showed that MIS also occurred in 9.9% of the infected adults age > 21 [12] , and thus the diagnosis of adult type (MIS-A) was established. As previously reported and our case presented, MIS-A commonly occur during the period of recovery after SARS-CoV-2 infection.…”

Multisystem inflammatory syndrome in adults: Characteristics, treatment, and outcomes

“…However, 42 (79.2%) patients required intensive care unit (ICU) admission, and 23 (43.4%) patients died 26 . A large single cohort study in Turkey reported that MIS‐A‐related mortality was 35.3% (82/233), and using the LDH/lymphocyte cutoff value of 0.32 can help predict mortality with 78% sensitivity and 70% specificity 32 . Based on Patel et al's 16 review, 110 (51%) of 214 and 101 (47%) of 213 patients required vasoactive medication and respiratory support, respectively.…”

“…Serin et al 32 conducted a large single‐center retrospective study in Turkey. They identified 232 (9.9%) cases of MIS‐A among 2333 hospitalized patients with COVID‐19 between March and December 2020 32 . The mean age was 62.1 years, and 143 (61.6%) patients were male.…”

“…Geographical distribution of reported cases of multisystem inflammatory syndrome in adults (as of October 26, 2022) 16,27–43 …”

A Case of Multisystem Inflammatory Syndrome in an Immunosuppressed Adult

“…The typical clinical presentation of MIS-A is fever and signs of inflammation [ 5 ]. While the identification of MIS-A is difficult, elevated inflammatory markers including C-reactive protein (CRP), ferritin, D-dimer, and interleukin (IL)-6 serve as valuable indicators for clinicians [ 6 ]. At present, definitive treatment for MIS-A remains unclear.…”