The emerging threat of multisystem inflammatory syndrome in adults (MIS-A) in COVID-19: A systematic review.
Shekhar Kunal, Pranav Ish, Pirabu Sakthivel and 2 others
PMID 35306376WHAT IT FOUND
Adults with MIS-A were mostly young men, with fever, rash, diarrhea and abdominal pain weeks after COVID.
Many had shock, reduced heart pumping and ICU care; 4 of 79 died.
Key findings
01Among 79 MIS-A cases, fever was reported in 100%, skin rash in 57.8%, diarrhea in 51.6% and abdominal pain in 40.6%, with cardiovascular involvement in 81%.
02Cardiac involvement was common: elevated troponin in 43/50 (86%), reduced left ventricular ejection fraction in 41 (73.2%), and shock in 40/78 (51.3%).
03Patients often received more than one treatment: steroids in 60.2%, IVIG in 37.2%, antibiotics in 60.2% and anticoagulants in 32%; 4 of 79 died and 75 were discharged.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies were case reports or case series, so the evidence level is low and no treatment effect can be inferred. Clinical features were available for 64 patients, ethnicity for 55 patients, echocardiography for 73 patients, troponin for 50 patients and BNP for 17 patients. The authors excluded reports that did not describe patients presenting with fever, and used the CDC definition for MIS-A. Treatment was highly variable and often multimodal, with steroids, IVIG, antibiotics and anticoagulants given together, so the contribution of any single therapy cannot be separated. The review covered publications only up to 31 August 2021, so later MIS-A experience is not included. The authors state that long-term sequelae are largely unknown. The authors note a risk of reporting bias and that the exact prevalence of MIS-A is largely unknown.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that steroids, IVIG, antibiotics or anticoagulants caused discharge or prevented death. Many patients received several treatments at once, and this review did not compare treatment groups.