Abstract
BackgroundOver 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).MethodsWe 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.ResultsWe 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).ConclusionThe 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.
Highlights
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, which is recognized as a leading cause of disability in working-age adults [1,2]
We aimed to study the reasons for admission and outcome in patients with multiple sclerosis (MS) admitted to a neuro-intensive care unit (NICU)
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
Summary
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, which is recognized as a leading cause of disability in working-age adults [1,2]. Immobility, involvement of vital neurological structures that may result in dysphagia and respiratory dysfunction as well as current MS medications pose a potential risk for the development of fatal complications [3,4] While many of these conditions require critical care, the pattern of neuro-intensive care unit (NICU) admissions among MS patients has so far not been sufficiently studied. A recent study has reported a higher risk of critical care admission and 1-year mortality in MS patients as compared to the general population [5] Given that both long-term and acute critical care of MS patients are very cost intensive [6,7], targeted interventions to reduce the need for consumption of critical care in MS patients would be paramount. We aimed to study the reasons for admission and outcome in patients with MS admitted to a neuro-intensive care unit (NICU).
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