1. Multisystem Inflammatory Syndrome in Adults: Case Finding Through Systematic Review of Electronic Medical Records.
- Author
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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, and Belay, Ermias D
- Subjects
ARTIFICIAL blood circulation ,HOSPICE care ,MULTISYSTEM inflammatory syndrome ,COVID-19 ,NOSOLOGY ,ADRENOCORTICAL hormones ,AGE distribution ,LEFT ventricular dysfunction ,RETROSPECTIVE studies ,ACQUISITION of data ,RACE ,ARTIFICIAL respiration ,SEX distribution ,HOSPITAL mortality ,RISK assessment ,HOSPITAL care ,SYMPTOMS ,MEDICAL records ,CRITICAL care medicine ,LONGITUDINAL method ,DISCHARGE planning - 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 FROM AUTHOR]
- Published
- 2022
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