Immune and coagulation profiles in 3 adults with multisystem inflammatory syndrome.
10.47102/annals-acadmedsg.2022290
- Author:
Ruth Xian Lynn YAP
1
;
Bernard Pui Lam LEUNG
;
Hwee Siew HOWE
;
Mung Ee LOH
;
Barnaby Edward YOUNG
;
Bingwen Eugene FAN
;
Xin Rong LIM
Author Information
1. Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
- Publication Type:Journal Article
- MeSH:
Humans;
Adult;
Male;
Middle Aged;
COVID-19/complications*;
Interleukin-10;
Interleukin-18;
Intercellular Adhesion Molecule-1;
Interleukin-17;
Chemokine CXCL10;
Interleukin-6;
SARS-CoV-2;
Connective Tissue Diseases;
Hemostatics
- From:Annals of the Academy of Medicine, Singapore
2023;52(2):80-87
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:There is a paucity of information on the cytokine, complement, endothelial activation, and coagulation profiles of multisystem inflammatory syndrome in adults (MIS-A), a rare but serious complication following recovery from SARS-CoV-2 infection. We aim to examine the immune biomarker and coagulation profiles in association with the clinical presentation and course of MIS-A.
METHOD:The clinical features of MIS-A patients admitted to our tertiary hospital were documented. Their levels of interleukin (IL)-1β, IL-6, IL-10, IL-17, IL-18, interferon-α (IFN-α), IFN-γ, interferon gamma-induced protein 10 (IP-10), tumour necrosis factor (TNF)-α, monocyte chemoattractant protein (MCP)-1, complement activation product (complement 5a [C5a]), and endothelial biomarker intercellular adhesion molecule-1 (ICAM-1) levels were assayed. The haemostatic profile was assessed with standard coagulation testing and thromboelastography.
RESULTS:Three male patients were diagnosed with MIS-A at our centre from January to June 2022 with a median age of 55 years. All had tested positive for SARS-CoV-2 12-62 days prior to MIS-A presentation, with gastrointestinal and cardiovascular systems as the most commonly involved. Levels of IL-6, IL-10, IL-18, IP-10 and MCP-1 were raised whereas IL-1β, IFN-α, IFN-γ, IL-17 and TNF-α remained normal. Markedly elevated levels of C-reactive protein (CRP), ferritin and ICAM-1 were present in all. C5a was elevated in 2 patients. A hypercoagulable state was demonstrated by raised levels of D-dimer, factor VIII, von Willebrand factor antigen, and ristocetin cofactor with corresponding raised parameters in thromboelastography in the 2 patients who had their coagulation profile assessed.
CONCLUSION:MIS-A patients demonstrate activation of pro-inflammatory cytokines, endotheliopathy, complement hyperactivation and hypercoagulability.
