A Multicenter Retrospective Cohort Study to Characterize Patients Hospitalized With Multisystem Inflammatory Syndrome in Adults and Coronavirus Disease 2019 in the United States, 2020-2021.
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Melgar Michael, Abrams Joseph Y, Godfred-Cato Shana, Shah Ami B, Garg Amit, Strunk Andrew, Narasimhan Mangala, Koptyev Jonathan, Norden Alexandra, Musheyev David, Rashid Fahmida, Tannenbaum Rachel, Estrada-Y-Martin Rosa M, Patel Bela, Karanth Siddharth, Achenbach Chad J, Hall Gavin T, Hockney Sara M, Caputo Matthew, Abbo Lilian M, Beauchamps Laura, Morris Stephen, Cifuentes Renzo O, de St Maurice Annabelle, Bell Douglas S, Prabaker Kavitha K, Sanz Vidorreta Fernando J, Bryant Evan, Cohen David K, Mohan Rohith, Libby Christopher P, SooHoo Spencer, Domingo Tristel J, Campbell Angela P, Belay Ermias D
Аннотация
METHODS: In this retrospective cohort study, we applied the US Centers for Disease Control and Prevention case definition to identify adults hospitalized with MIS-A at 6 academic medical centers from 1 March 2020 to 31 December 2021. Patients MIS-A were matched by age group, sex, site, and admission date at a 1:2 ratio to patients hospitalized with acute symptomatic COVID-19. Conditional logistic regression was used to compare demographic characteristics, presenting symptoms, laboratory and imaging results, treatments administered, and outcomes between cohorts.
RESULTS: Through medical record review of 10 223 patients hospitalized with SARS-CoV-2-associated illness, we identified 53 MIS-A cases. Compared with 106 matched patients with COVID-19, those with MIS-A were more likely to be non-Hispanic black and less likely to be non-Hispanic white. They more likely had laboratory-confirmed COVID-19 ≥14 days before hospitalization, more likely had positive in-hospital SARS-CoV-2 serologic testing, and more often presented with gastrointestinal symptoms and chest pain. They were less likely to have underlying medical conditions and to present with cough and dyspnea. On admission, patients with MIS-A had higher neutrophil-to-lymphocyte ratio and higher levels of C-reactive protein, ferritin, procalcitonin, and D-dimer than patients with COVID-19. They also had longer hospitalization and more likely required intensive care admission, invasive mechanical ventilation, and vasopressors. The mortality rate was 6% in both cohorts.
CONCLUSIONS: Compared with patients with acute symptomatic COVID-19, adults with MIS-A more often manifest certain symptoms and laboratory findings early during hospitalization. These features may facilitate diagnosis and management.