The emerging threat of multisystem inflammatory syndrome in adults (MIS-A) in COVID-19: A systematic review

Kunal, Shekhar; Ish, Pranav; Sakthivel, Pirabu; Malhotra, Nipun; Gupta, Kashish

doi:10.1016/j.hrtlng.2022.03.007

Cited by 45 publications

(69 citation statements)

References 66 publications

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“…Treatment generally causes normalisation of LVEF after 1 week. 22 , 23 , 31 , 32 , 33 Mortality is 1.9% in MIS‐C and 7% in MIS‐A and has been reported in patients that require mechanical circulatory support and do not show improvement in LVEF. 22 , 35 …”

Section: Discussionmentioning

confidence: 95%

“… 21 Currently, more than 221 MIS‐A cases have been reported and analysed in two systematic reviews. 22 , 23 Patients generally develop MIS‐A four weeks after COVID‐19 infection. Most are male (70%) and 21–34 years old, but the oldest is 84 years.…”

Section: Discussionmentioning

confidence: 99%

“… 31 Cardiovascular findings in MIS‐C/A include perimyocarditis (11–33%), hypotension and shock (50–60%), coronary artery dilatation or aneurysm (4–8%), mitral regurgitation (14%) and arrhythmia (12–18%). 22 , 23 , 31 , 32 , 33 Left ventricular dysfunction is present in 55% of adults with mean left ventricular ejection fraction (LVEF) 39%. 22 , 23 Left ventricular dysfunction with ejection fraction <55% is present in 38% of MIS‐C patients.…”

Section: Discussionmentioning

confidence: 99%

“… 22 , 23 , 31 , 32 , 33 Left ventricular dysfunction is present in 55% of adults with mean left ventricular ejection fraction (LVEF) 39%. 22 , 23 Left ventricular dysfunction with ejection fraction <55% is present in 38% of MIS‐C patients. 31 , 32 , 33 Additionally, 28.6% of MIS‐A patients and 3% of MIS‐C patients show severe LV dysfunction with LVEF <30%.…”

Section: Discussionmentioning

confidence: 99%

“… 31 , 32 , 33 Additionally, 28.6% of MIS‐A patients and 3% of MIS‐C patients show severe LV dysfunction with LVEF <30%. 22 , 23 , 31 , 32 , 33 Patients with LVEF <45% are more likely to present in shock (60% vs 9%) and be admitted to ICU (100% vs 55%) as compared to patients with LVEF ≥45%. 34 Patients with lower LVEF also resided longer on ICU with more need for inotropy, but showed no significant differences in total hospital stay, ventilatory support or mortality.…”

Section: Discussionmentioning

confidence: 99%

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SARS‐CoV‐2‐related Multisystem Inflammatory Syndrome in Adult complicated by myocarditis and cardiogenic shock

et al. 2022

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Multisystem Inflammatory Syndrome in Adult (MIS-A) is a rare COVID-19 complication, presenting as fever with laboratory evidence of inflammation, severe illness requiring hospitalization and multisystem organ involvement. We report on a 25-year-old man presenting with fever, rash, abdominal pain, diarrhoea and vomiting following prior asymptomatic COVID-19 infection. He developed refractory shock and type 1 respiratory insufficiency requiring mechanical ventilation. Diagnostic testing revealed significant inflammation, anemia, thrombocytopenia, acute kidney injury, hepatosplenomegaly, colitis, lymphadenopathy and myocarditis necessitating inotropy. Ventilatory, vasopressor and inotropic support was weaned following pulse corticosteroids and intravenous immunoglobulins. Heart failure therapy was started. Short-term follow-up shows resolution of inflammation and cardiac dysfunction.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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SARS‐CoV‐2‐related Multisystem Inflammatory Syndrome in Adult complicated by myocarditis and cardiogenic shock

et al. 2022

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

Lai

Hsu

Hsueh

et al. 2023

Journal of Medical Virology

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Following the rapidly increasing number of multisystem inflammatory syndromes in children (MIS‐C), a similar clinical scenario has been observed in adult patients. Although its prevalence is low and probably related to underdiagnosis, its development can be associated with high mortality. Multisystem inflammatory syndrome in adults (MIS‐A) can develop following both asymptomatic and symptomatic severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and in previously healthy people. Like MIS‐C, MIS‐A is a multisystem disease that can involve the cardiovascular, respiratory, gastrointestinal, dermatologic, hematologic, and neurologic systems. In addition to the clinical manifestations, the diagnosis of MIS‐A requires laboratory evidence of inflammation and SARS‐CoV‐2 infection. The appropriate treatment for MIS‐A remains unclear; anti‐inflammatory agents, including intravenous immunoglobulin and corticosteroids, are commonly used. However, there are still many unknowns regarding MIS‐A. Further studies are needed to determine the true prevalence, pathogenesis, and effective treatment for MIS‐A.

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Multisystem inflammatory syndrome in adults associated with COVID‐19: A rare life‐threatening complication

Zafar,

Gonzalez,

Wang

et al. 2023

Rheumatology & Autoimmunity

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The emerging threat of multisystem inflammatory syndrome in adults (MIS-A) in COVID-19: A systematic review

Cited by 45 publications

References 66 publications

SARS‐CoV‐2‐related Multisystem Inflammatory Syndrome in Adult complicated by myocarditis and cardiogenic shock

SARS‐CoV‐2‐related Multisystem Inflammatory Syndrome in Adult complicated by myocarditis and cardiogenic shock

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

Multisystem inflammatory syndrome in adults associated with COVID‐19: A rare life‐threatening complication

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