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Clinical Characteristics of Multisystem Inflammatory Syndrome in AdultsA Systematic Review

Educational Objective
To identify the key insights or developments described in this article
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Key Points

Question  What are the clinical characteristics of multisystem inflammatory syndrome in adults (MIS-A)?

Findings  This systematic review of patients with MIS-A reported in the literature and to the US Centers for Disease Control and Prevention identified 221 patients worldwide. The syndrome presented approximately 4 weeks after acute COVID-19 with hyperinflammation and extrapulmonary multiorgan involvement that may be difficult to discern from acute biphasic COVID-19 and postacute sequelae of SARS-CoV-2 infection.

Meaning  These findings suggest that MIS-A occurs in the postacute COVID-19 period with a heterogeneous clinical presentation likely owing to a dysregulated immune response.


Importance  Multisystem inflammatory syndrome in adults (MIS-A) has not been well described. Improved diagnosis and treatment of MIS-A might mitigate COVID-19 morbidity and mortality.

Objective  To summarize the descriptive epidemiology and clinical characteristics of MIS-A.

Evidence Review  This systematic review identified patients with MIS-A using 3 strategies: (1) literature review from May 1, 2020, to May 25, 2021, by searching MEDLINE, Embase, Global Health, CAB Abstracts, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Academic Search Complete, Scopus, World Health Organization Global COVID-19 Literature Database, and Google Scholar; (2) voluntary reports of MIS-A to the Centers for Disease Control and Prevention (CDC); and (3) reports among persons aged 18 to 20 years in the CDC surveillance system for MIS in children.

Findings  Of 221 patients with MIS-A, the median age was 21 (interquartile range [IQR], 19-34) years, and 154 of 219 (70%) with data available were men. Sixty of 169 patients (36%) were non-Hispanic Black individuals, and 122 of 209 (58%) had no underlying comorbidity. One hundred two of 149 patients (68%) noted a previous symptomatic COVID-19–like illness (median, 28 [IQR, 20-36] days previously). Most patients with MIS-A presented with fever (197 of 205 [96%]), hypotension (133 of 220 [60%]), cardiac dysfunction (114 of 210 [54%]), shortness of breath (102 of 198 [52%]), and/or diarrhea (102 of 197 [52%]). The median number of organ systems involved was 5 (IQR, 4-6). Median hospital stay was 8 (IQR, 5-12) days; 115 of 201 patients (57%) were admitted to the intensive care unit; 101 of 213 (47%) required respiratory support, and 15 of 220 (7%) died. Most patients (176 of 195 [90%]) had elevated markers of coagulopathy and/or inflammation and a positive SARS-CoV-2 serologic finding (139 of 194 [72%]). Ten patients with MIS-A presented with Kawasaki disease.

Conclusions and Relevance  These findings suggest that MIS-A is a serious hyperinflammatory condition that presents approximately 4 weeks after onset of acute COVID-19 with extrapulmonary multiorgan dysfunction.

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Article Information

Accepted for Publication: July 6, 2021.

Published: September 22, 2021. doi:10.1001/jamanetworkopen.2021.26456

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Patel P et al. JAMA Network Open.

Corresponding Author: Pragna Patel, MD, MPH, CDC COVID-19 Response, Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333 (

Author Contributions: Drs Patel and Abrams had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Patel.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Patel.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Patel, DeCuir, Abrams.

Supervision: Patel, Godfred-Cato, Belay.

Conflict of Interest Disclosures: None reported.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

Additional Contributions: We recognize all our state and local jurisdiction partners who submit cases to the US CDC through the surveillance system for multisystem inflammatory syndrome (MIS) in children, as well as those who work tirelessly to maintain the system, especially the CDC MIS data team.

Centers for Disease Control and Prevention Coronavirus-19 (COVID-19) tracker. Updated January 5, 2021. Accessed on January 6, 2021.
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