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

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

Anush Karamyan  1 , Martin W Dünser  2 , Douglas J Wiebe  3 , Georg Pilz  1 , Peter Wipfler  1 , Vaclav Chroust  1 , Helmut F Novak  1 , Larissa Hauer  4 , Eugen Trinka  1 , Johann Sellner  1   5
Affiliations

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

Anush Karamyan et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: 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. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. There are no restrictions on sharing of data and/or materials related to this work.

Figures

Fig 1
Fig 1. Patient population flowchart.
*Admissions for plasmapheresis series (usually a total of 5 exchanges administered every other day) were considered as a single admission. **After excluding admissions for a planned intervention and adjusting the matching for mortality analysis.
See this image and copyright information in PMC

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