背景:成人SARS-CoV-2相关多系统炎症综合征(MIS-A)的诊断需要将其与急性COVID-19区分开来,并可能影响临床治疗。
方法:在这项回顾性队列研究中,我们应用美国疾病控制和预防中心的病例定义,确定2020年3月1日至2021年12月31日期间在6个学术医疗中心接受MIS-A治疗的成人.MIS-A患者按年龄组匹配,性别,site,和入院日期与有急性症状的COVID-19住院患者的比例为1:2。条件逻辑回归用于比较人口统计,出现症状,实验室和成像结果,管理的治疗,以及队列之间的结果。
结果:通过对10,223例SARS-CoV-2相关疾病住院患者的病历回顾,我们确定了53例MIS-A病例。与106例匹配的COVID-19患者相比,MIS-A患者更可能是非西班牙裔黑人,而非西班牙裔白人的可能性较小。MIS-A患者更有可能在住院前14天经实验室确诊的COVID-19,更有可能有积极的院内SARS-CoV-2血清学检测,更常出现胃肠道症状和胸痛。他们不太可能有潜在的医疗条件和出现咳嗽和呼吸困难。一入场,MIS-A患者的中性粒细胞与淋巴细胞比率较高,C反应蛋白,铁蛋白,降钙素原和D-二聚体,与COVID-19患者相比。MIS-A患者住院时间更长,更有可能需要重症监护,有创机械通气,和血管加压药。两组死亡率均为6%。
结论:与有急性症状的COVID-19患者相比,患有MIS-A的成年人在住院期间更容易出现某些症状和实验室检查结果。这些特征可以促进诊断和管理。
The diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated multisystem inflammatory syndrome in adults (MIS-A) requires distinguishing it from acute coronavirus disease 2019 (COVID-19) and may affect clinical management.
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.
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.
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.