Singapore Institute of Technology
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Immune and coagulation profiles in 3 adults with multisystem inflammatory syndrome

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posted on 2023-04-20, 08:09 authored by Ruth Xian Lynn Yap, Pui Lam Bernard LeungPui Lam Bernard Leung, Hwee Siew Howe, Mung Ee Loh, Barnaby Edward Young, Bingwen Eugene Fan, Xin Rong Lim

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.


This work is supported by the research fund of the Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital.


Journal/Conference/Book title

Annals of the Academy of Medicine, Singapore

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This is the publisher's PDF version of: Yap, R. X. L., B. P. Leung, H. S. Howe, M. E. Loh, B. E. Young, B. E. Fan, and X. R. Lim. 2023. Immune and coagulation profiles in 3 adults with multisystem inflammatory syndrome. Ann Acad Med Singap 52: 80-87.

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Lim Xin Rong, Email:

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