Table 2.
Characteristics of Patients With Multisystem Inflammatory Syndrome in Adults by COVID-19 Vaccination Status, December 2020 to April 2021, United States
| Total (n = 20) | Vaccinated
(n = 7) |
Unvaccinated(n = 13) | P-value | |
|---|---|---|---|---|
| Age in years, median (range) | 35 (21–66) | 37 (22–49) | 35 (21–66) | .843 |
| Sex | .022 | |||
| Female | 7 (35%) | 5 (71%) | 2 (15%) | |
| Male | 13 (65%) | 2 (29%) | 11 (85%) | |
| Race/Ethnicity | ||||
| Non-Hispanic Asian | 2 (10%) | 0 (0%) | 2 (15%) | .521 |
| Hispanic | 2 (10%) | 0 (0%) | 2 (15%) | .521 |
| Multiple | 1 (5%) | 1 (14%) | 0 (0%) | .350 |
| Non-Hispanic Black | 7 (35%) | 2 (29%) | 5 (38%) | 1.000 |
| Non-Hispanic White | 8 (40%) | 4 (57%) | 4 (31%) | .356 |
| Signs and symptoms | ||||
| Diarrhea | 16 (80%) | 7 (100%) | 9 (69%) | .249 |
| Abdominal pain | 12 (60%) | 6 (86%) | 6 (46%) | .158 |
| Vomiting | 12 (60%) | 3 (43%) | 9 (69%) | .356 |
| Rash | 11 (55%) | 3 (43%) | 8 (62%) | .642 |
| Headache | 11 (55%) | 3 (43%) | 8 (62%) | .642 |
| Shortness of breath | 9 (45%) | 5 (71%) | 4 (31%) | .160 |
| Chest pain or tightness | 7 (35%) | 2 (29%) | 5 (38%) | 1.000 |
| Cough | 6 (30%) | 4 (57%) | 2 (15%) | .122 |
| Conjunctival injection | 5 (25%) | 2 (29%) | 3 (23%) | 1.000 |
| Clinical findings | ||||
| Hypotension | 16 (80%) | 6 (86%) | 10 (77%) | 1.000 |
| Shock | 15 (75%) | 6 (86%) | 9 (69%) | .613 |
| Cardiac dysfunction | 15 (75%) | 6 (86%) | 9 (69%) | .613 |
| Myocarditis | 14 (70%) | 4 (57%) | 10 (77%) | .613 |
| Acute kidney injury | 12 (60%) | 4 (57%) | 8 (62%) | 1.000 |
| Pleural effusion | 10 (50%) | 4 (57%) | 6 (46%) | .350 |
| Pericardial effusion | 9 (45%) | 5 (71%) | 4 (31%) | .160 |
| Pneumonia | 8 (40%) | 3 (43%) | 5 (38%) | 1.000 |
| Mitral regurgitation | 7 (35%) | 2 (29%) | 5 (38%) | 1.000 |
| ARDS | 2 (10%) | 0 (0%) | 2 (15%) | .521 |
| Coronary artery dilatation or aneurysm | 1 (5%) | 0 (0%) | 1 (8%) | 1.000 |
| Laboratory tests | ||||
| Elevated troponin | 17 (85%) | 6 (86%) | 11 (85%) | 1.000 |
| Elevated BNP or NT-proBNP | 16 (80%) | 6 (86%) | 10 (77%) | 1.000 |
| Thrombocytopenia | 9 (45%) | 4 (57%) | 7 (54%) | .642 |
| Lymphopenia | 13 (65%) | 4 (57%) | 9 (69%) | .651 |
| Treatment | ||||
| Steroids | 19 (95%) | 7 (100%) | 12 (92%) | 1.000 |
| Respiratory support, any | 14 (70%) | 6 (86%) | 8 (62%) | .354 |
| IVIG | 13 (65%) | 6 (86%) | 7 (54%) | .329 |
| Anticoagulation medication | 13 (65%) | 2 (29%) | 11 (85%) | .022 |
| Vasoactive medications | 12 (60%) | 4 (57%) | 8 (62%) | 1.000 |
| Antiplatelet medication | 9 (45%) | 3 (43%) | 6 (46%) | 1.000 |
| Intubation and mechanical ventilation | 6 (30%) | 2 (29%) | 4 (31%) | 1.000 |
| Immune modulatorsa | 4 (20%) | 2 (29%) | 2 (15%) | .587 |
| Outcome | ||||
| Days in hospital, median (range) | 6 (2–41) | 6 (3–10) | 6 (2–41) | .685 |
| ICU admission | 14( 70%) | 5 (71%) | 9 (69%) | 1.000 |
| Died | 2 (10%) | 1 (14%) | 1 (8%) | 1.000 |
| SARS-CoV-2 testing | ||||
| Any positive laboratory test | 20 (100%) | 7 (100%) | 13 (100%) | 1.000 |
| PCR positive/Serology negative, not done, or missing | 5 (25%) | 2 (29%) | 3 (23%) | 1.000 |
| Serology positive/PCR negative | 5 (25%) | 1 (14%) | 4 (31%) | .613 |
| PCR positive/Serology positive | 10 (50%) | 4 (57%) | 6 (46%) | 1.000 |
| Vaccine doses | ||||
| 0 dose | 13 (65%) | 0 (0%) | 13 (100%) | … |
| 1 dose | 3 (15%) | 3 (43%) | 0 (0%) | … |
| 2 dosesb | 4 (20%) | 4 (57%) | 0 (0%) | … |
| Preceding COVID-like illness | 16 (80%) | 6 (86%) | 10( 77%) | 1.000 |
| Days from COVID-19 onset to MIS-A onset, median (range) | 26 (11–78) | 28 (25–43) | 26 (11–78) | .913 |
| Days from vaccination (1st dose) to MIS-A onset, median (range) | 10 (6–45) | 10 (6–45) | -
- |
… |
Abbreviations: ARDS, acute respiratory distress syndrome; BNP, B-natriuretic peptide; COVID-19, coronavirus disease 2019; ICU, intensive care unit; IVIG, intravenous immunoglobulin; MIS-A, multisystem inflammatory syndrome in adults; PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Immunomodulators were used in 4 patients: 3 received Anakinra and the 4th patient received tocilizumab.
The 2nd dose in 1 patient was administered after recovery from MIS-A illness (Figure 1).