Clinical features and outcomes of patients with myasthenia gravis admitted to an intensive care unit: A 20-year retrospective study

R Morar; GEMP 2 Group 6 of 2018 (M Amod, F Chappel, L Ebbeling, L Fikizolo, A Glover, K Gutu, C Lawson, R Maswinyaneng, M Mohunlal, K Morar, D Rooken-Smith, K Seale, D Shai); F Seedat; G A Richards

doi:10.7196/SAJCC.2023.v39i2.561

Clinical features and outcomes of patients with myasthenia gravis admitted to an intensive care unit: A 20-year retrospective study

South Afr J Crit Care. 2023 Jul 28;39(2):10.7196/SAJCC.2023.v39i2.561. doi: 10.7196/SAJCC.2023.v39i2.561. eCollection 2023.

Authors

R Morar¹; GEMP 2 Group 6 of 2018 (M Amod, F Chappel, L Ebbeling, L Fikizolo, A Glover, K Gutu, C Lawson, R Maswinyaneng, M Mohunlal, K Morar, D Rooken-Smith, K Seale, D Shai); F Seedat¹, G A Richards¹

Affiliation

¹ School of Clinical Medicine, Faculty of Health Sciences; Division of Pulmonology and Critical Care, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: There are limited data on the clinical characteristics and outcomes of patients with myasthenia gravis (MG) admitted to the intensive care unit (ICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).

Objectives: The aim was to study the clinical characteristics and outcomes of patients with MG admitted to the CMJAH over two decades.

Methods: A retrospective study was undertaken of patients with MG admitted to the multidisciplinary ICU of CMJAH over a 20-year period, from 1998 to 2017. Demographic data, clinical features, management and outcomes of patients were assessed and reviewed from the case records.

Results: Thirty-four patients with MG were admitted to the ICU during this period: 24 female and 10 male. The mean age ± SD was 37.4 ± 13.0 years, with a range of 16 - 66 years. Four patients were human immunodeficiency virus (HIV)-positive. The mean length of stay (LOS) in ICU was 10.6 ± 20.1 days, ranging from 1 to 115 days. Two patients were diagnosed with MG in the ICU after failure to wean from the ventilator. Overall, 22 patients were intubated and ventilated on admission. Morbidities included self-extubation, aspiration pneumonia and iatrogenic pneumothorax. History of thymectomy was present in 12 patients. The treatments received for MG included pyridostigmine (73.5%), corticosteroids (55.9%), azathioprine (35.3%), plasmapheresis (26.5%) and intravenous immunoglobulin (8.8%). The overall mortality in the ICU was 5.9%.

Conclusion: MG is a serious disorder with considerable morbidity and mortality. It is, however, a potentially manageable disease, provided that appropriate ICU resources are available.

Contributions of the study: This study provides further insight into the characteristics and outcomes of myasthenia gravis patients in ICU, within a South African context.

Keywords: ICU; Johannesburg, South Africa; Myasthenia gravis; critical care.

Copyright © 2022, Morar et al. Copyright of published material remains in the Authors’ name. This allows authors to use their work for their own non-commercial purposes without seeking permission from the Publisher, subject to properly acknowledging the Journal as the original place of publication.