Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Oct;72(4):636-642.
doi: 10.1002/mus.28475. Epub 2025 Jul 23.

Predictors of Outcome in Myasthenic Crisis

Ahmad R Abuzinadah  1   2 , Mohammed H Alanazy  3 , Nadeem Shafique Butt  4 , Ziad H Alzabidi  5 , Marwa L Alrehaili  6 , Laila Alqahtani  7 , Areej Abdulrahman Bushnag  8 , Hussien Salem Alkully  8 , AlBaraa Ali Beck  8 , Seraj Makkawi  9   10   11 , Alaa Maglan  9   10   11 , Alanood Alsolaihim  12   13 , Ali Alshehri  12   13 , Mossaed Mohammed Alyahya  12   13 , Muteb Khidhran Alotaibi  14 , Shahad Jamal Aljasir  14 , Aysha A Alshareef  1   2 , Ahmed K Bamaga  2   15 , Ahmad Abdulaziz Abulaban  7   16   17 ; Saudi Arabia Neuromuscular and Electrodiagnostic Medicine (SANEM) Research Group
Affiliations
Multicenter Study

Predictors of Outcome in Myasthenic Crisis

Ahmad R Abuzinadah et al. Muscle Nerve. 2025 Oct.

Abstract

Introduction/aims: The impact of maintenance steroid sparing immunosuppression (SSIS) and prednisone dosage on myasthenic crisis (MC) outcomes and their effects on the development of sepsis have not been well described. This study aimed to investigate the predictive value of these variables on MC outcomes.

Methods: This retrospective, multi-center study examined the potential predictors of MC outcomes using univariate and multivariate analyses through mixed-effect logistic regression and Cox proportional hazards regression.

Results: We included 57 MCs that occurred in 52 patients with a median age of 55 years (interquartile range [IQR]: 33-66), 26 of whom (45.6%) were male. Multivariate analysis showed that sepsis was associated with prolonged length of intensive care unit (ICU) stay (hazard ratio [HR] for time to discharge from the ICU: 0.27, 95% confidence interval [CI]: 0.11-0.71) and duration of ventilation (HR for time to extubation: 0.28, 95% CI: 0.12-0.67). Predictors of sepsis development were age > 50 years (odds ratio [OR]: 7.74, 95% CI: 1.29-46.53) and prednisone use of ≥ 60 mg/day during ICU stay (OR: 13.07, 95% CI: 2.17-86.73). The presence of maintenance SSIS at MC onset predicted a shorter length of ICU stay (HR for time to discharge from the ICU: 2.23, 95% CI: 1.13-4.42) and duration of ventilation (HR for time to extubation: 2.73, 95% CI: 1.37-5.43).

Discussion: The presence of maintenance SSIS at MC onset and the prevention of sepsis are measures that could improve MC outcomes. The use of lower doses (< 60 mg/day) of prednisone, when feasible, could mitigate the risk of sepsis in MC.

Keywords: intubation; myasthenia gravis; myasthenic crisis; outcome; sepsis.

PubMed Disclaimer

References

    1. B. Claytor, S. M. Cho, and Y. Li, “Myasthenic Crisis,” Muscle & Nerve 68, no. 1 (2023): 8–19.
    1. L. C. Wendell and J. M. Levine, “Myasthenic Crisis,” Neurohospitalist 1, no. 1 (2011): 16–22.
    1. N. M. Engel‐Nitz, A. Boscoe, R. Wolbeck, J. Johnson, and N. J. Silvestri, “Burden of Illness in Patients With Treatment Refractory Myasthenia Gravis,” Muscle & Nerve 58 (2018): 99–105.
    1. C. E. Thomas, S. A. Mayer, Y. Gungor, et al., “Myasthenic Crisis: Clinical Features, Mortality, Complications, and Risk Factors for Prolonged Intubation,” Neurology 48, no. 5 (1997): 1253–1260.
    1. F. Liu, Q. Wang, and X. Chen, “Myasthenic Crisis Treated in a Chinese Neurological Intensive Care Unit: Clinical Features, Mortality, Outcomes, and Predictors of Survival,” BMC Neurology 19, no. 1 (2019): 172–181.

Publication types

LinkOut - more resources