COVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis

Iran J Allergy Asthma Immunol. 2020 Dec 19;19(6):570-588. doi: 10.18502/ijaai.v19i6.4927.


The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: ("novel coronavirus" Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.

Keywords: Coronavirus; Kawasaki disease; Multisystem inflammatory syndrome in children; Severe acute respiratory syndrome coronavirus 2.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Abdominal Pain / physiopathology
  • Acute Kidney Injury / physiopathology
  • COVID-19 / epidemiology
  • COVID-19 / physiopathology*
  • COVID-19 / therapy
  • Cheilitis / physiopathology
  • Conjunctivitis / physiopathology*
  • Cough / physiopathology
  • Diarrhea / physiopathology
  • Dyspnea / physiopathology
  • Exanthema / physiopathology*
  • Fever / physiopathology*
  • Gastrointestinal Diseases / physiopathology*
  • Headache / physiopathology
  • Humans
  • Meningism / physiopathology
  • Myalgia / epidemiology
  • Prognosis
  • Respiration, Artificial
  • Sex Distribution
  • Shock / physiopathology*
  • Systemic Inflammatory Response Syndrome / epidemiology
  • Systemic Inflammatory Response Syndrome / physiopathology*
  • Systemic Inflammatory Response Syndrome / therapy
  • Vomiting / physiopathology

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related