Critical Illness in Patients with Multiple Sclerosis: A Matched Case-Control Study

Anush Karamyan; Martin W Dünser; Douglas J Wiebe; Georg Pilz; Peter Wipfler; Vaclav Chroust; Helmut F Novak; Larissa Hauer; Eugen Trinka; Johann Sellner

doi:10.1371/journal.pone.0155795

Critical Illness in Patients with Multiple Sclerosis: A Matched Case-Control Study

PLoS One. 2016 May 31;11(5):e0155795. doi: 10.1371/journal.pone.0155795. eCollection 2016.

Authors

Affiliations

¹ Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, and Center for Cognitive Neuroscience, Salzburg, Austria.
² Department of Anesthesiology, Perioperative and General Intensive Care Medicine, University Hospital Salzburg and Paracelsus Medical University, Salzburg, Austria.
³ Department of Biostatistics and Epidemiology, Perelman School of Medicine University of Pennsylvania, PA, United States of America.
⁴ Department of Psychiatry, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
⁵ Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.

Abstract

Background: Over the course of multiple sclerosis (MS) several conditions may arise that require critical care. We aimed to study the reasons for admission and outcome in patients with MS admitted to a neuro-intensive care unit (NICU).

Methods: We retrospectively searched the electronic charts of a 9-bedded NICU in a tertiary hospital for patients with a diagnosis of multiple sclerosis (MS) from 1993-2015, and matched them to NICU controls without MS based on age and gender. Conditional logistic regression was used to compare admission causes, Charlson's Comorbidity Index, indicators of disease severity, and survival between MS and non-MS patients.

Results: We identified 61 MS patients and 181 non-MS controls. Respiratory dysfunction was the most frequent reason for NICU admission among MS patients (34.4%), having infectious context as a rule. In a matched analysis, after adjusting for co-morbidities and immunosuppressive medications, patients with MS were more likely to be admitted to the NICU because of respiratory dysfunction (OR = 7.86, 95% CI 3.02-20.42, p<0.001), non-respiratory infections (OR = 3.71, 95% CI 1.29-10.68, p = 0.02), had a higher rate of multiple NICU admissions (OR = 2.53, 95% CI 1.05-6.05, p = 0.04) than non-MS patients. Mortality after NICU admission at a median follow-up time of 1 year was higher in MS than control patients (adjusted OR = 4.21, 95% CI 1.49-11.85, p = 0.04).

Conclusion: The most common reason for NICU admission in MS patients was respiratory dysfunction due to infection. Compared to non-MS patients, critically ill MS patients had a higher NICU re-admission rate, and a higher mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Case-Control Studies
Comorbidity
Critical Care / statistics & numerical data*
Critical Illness / mortality
Female
Hospitalization
Humans
Intensive Care Units / statistics & numerical data*
Male
Middle Aged
Multiple Sclerosis / mortality*
Patient Admission / statistics & numerical data
Retrospective Studies

Grants and funding

This study was in part supported by an unrestricted grant from Merck. JS has received research funding from the Paracelsus Medical University, Bayer, Biogen-Idec, Merck and Novartis, has acted as paid consultant to Novartis and Genzyme, and has received speakers’ honoraria from Biogen-Idec, Ever Neuropharma, Genzyme, Novartis and Teva-Ratiopharm. There was no additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.