Identification and description of patients with multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection using the Premier Healthcare Database.

Jennifer Decuir,Ermias D Belay,Michael Melgar,Shana Godfred-Cato,Pragna Patel,Karen K Wong,Noah G Schwartz,James Baggs,Sapna Bamrah Morris

doi:10.1017/s0950268822000024

Abstract

Multisystem inflammatory syndrome in adults (MIS-A) is a hyperinflammatory illness related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The characteristics of patients with this syndrome and the frequency with which it occurs among patients hospitalised after SARS-CoV-2 infection are unclear. Using the Centers for Disease Control and Prevention case definition for MIS-A, we created ICD-10-CM code and laboratory criteria to identify potential MIS-A patients in the Premier Healthcare Database Special COVID-19 Release, a database containing patient-level information on hospital discharges across the United States. Modified MIS-A criteria were applied to hospitalisations with discharge from March to December 2020. The proportion of hospitalisations meeting electronic health record criteria for MIS-A and descriptive statistics for patients in the potential MIS-A cohort were calculated. Of 34 515 SARS-CoV-2-related hospitalisations with complete clinical and laboratory data, 53 met modified criteria for MIS-A (0.15%). The median age was 62 years (IQR 52-74). Most patients met the severe cardiac illness criterion through either myocarditis (66.0%) or new-onset heart failure (35.8%). A total of 79.2% of patients required ICU admission, while 43.4% of patients in the cohort died. MIS-A appears to be a rare but severe outcome of SARS-CoV-2 infection. Additional studies are needed to investigate how this syndrome differs from severe coronavirus disease 2019 (COVID-19) in adults.

Highlights

As the coronavirus disease 2019 (COVID-19) pandemic has progressed, our understanding of the natural history of infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved
To assess how commonly multisystem inflammatory syndrome in adults (MIS-A) occurs among patients hospitalised with SARS-CoV-2-related illness and to describe the clinical characteristics of this condition, we applied criteria adapted from the Centers for Disease Control and Prevention (CDC) case definition for multisystem inflammatory syndrome (MIS)-A to the PHD-SR
Our results suggest that MIS-A is a very rare outcome of SARS-CoV-2 infection

Summary

Introduction

As the coronavirus disease 2019 (COVID-19) pandemic has progressed, our understanding of the natural history of infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved. Accumulating evidence has identified multiple phenotypes of disease that appear to be associated with SARS-CoV-2 infection, including acute COVID-19, multisystem inflammatory syndrome (MIS), and other post-COVID conditions [1, 2]. Patients may present with mucocutaneous manifestations similar to those observed in Kawasaki disease, including rash, non-purulent conjunctivitis, and oral mucosal changes [4, 9, 10]. Gastrointestinal symptoms, such as diarrhoea, abdominal pain, and vomiting, are common [5].

Methods

Results

Conclusion