DOI: 10.1097/ms9.0000000000000732 ISSN:

A global systematic review and meta-analysis on the emerging evidence on risk factors, clinical characteristics, and prognosis of multisystem inflammatory syndrome in Adults (MIS-A)

Mohammad Aadil Qamar, Syed Shabbir Afzal, Rubaid Azhar Dhillon, Mir Ibrahim Sajid, Zouina Sarfraz, Azza Sarfraz, Mehek Narmeen, Omar Irfan, Ivan Cherrez-Ojeda, Ali Bin Sarwar Zubairi
  • General Medicine
  • Surgery


The multisystem inflammatory syndrome in adults (MIS-A) has emerged, similar to those in children associated with SARS-Co-V-2 (MIS-C). This review aimed to analyze the risk factors, clinical course, and prognosis of the multisystem inflammatory syndrome in adults (MIS-A).


A comprehensive literature search was conducted using several databases for cases reporting MIS-A from December 1, 2019, till September 9, 2021. The case definitions used to identify potential cases were those recommended by the World Health Organization, Center for Disease Control, and individual country/physician classification. The meta-analysis was performed using Comprehensive Meta-Analysis 2.2.027 and RevMan 5.4.1, employing 95% confidence intervals (CI).


Seventy studies were assessed for full-text eligibility, out of which 37 were included. The mean age of study population was 32.52±10.29 years. The most common symptoms were fever (89.8%, 95% CI: 77.7% to 95.7%) and diarrhea (49%, 95% CI: 35.4% to 62.7%). Ventricular tachycardia (57.1%, 95% CI: 43.1% to 70.1%) was the most common electro-cardiac abnormality. The most common inflammatory marker was elevated C-Reactive protein (89.8%, 95% CI: 77.7% to 95.7%). Abnormal echocardiogram was the most common imaging test result (commonly, ventricular dysfunction and arrhythmias), while steroids were the most administered treatment. Severe cases had a higher need for vasopressor and inotropic support and antibiotic therapy compared to the non-severe cases. One death was reported due to cardiovascular failure.


Our collated findings will help clinicians identify the typical presenting symptoms and optimal management of MIS-A. Further research is required to understand the long-term prognosis and the correlation between COVID-19 and MIS-A to understand its pathogenesis and clinical spectrum.

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