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Hospital admission due to infections in multiple sclerosis patients
S Montgomery1, J Hillert, S Bahmanyar
1Clinical Epidemiology and Biostatistics, Örebro University Hospital and Örebro University, Örebro, Sweden. scott.montgomery@orebroll.se
Background And Purpose:
Multiple sclerosis (MS) patients are at increased infection risk. Here the influences of susceptibility, severity and surveillance bias on infection-related hospital admission are assessed.
Methods:
Swedish registers identified 20,276 patients with MS, matched with 203,951 people from the general population without MS. Risk of first hospital admission for infection and mortality over 36 years was estimated by Poisson regression.
Results:
Multiple sclerosis was associated with an increased hospital admission risk for all infections, with an adjusted relative risk (and 95% confidence interval) of 4.26 (4.13-4.40). A proportion of this raised risk was probably due to surveillance and referral bias, although a raised risk remained when MS was compared with other immune-mediated diseases. The 1-month mortality rate following hospital admission for infection was higher in MS patients than in the comparison cohort, with a relative risk of 4.69 (4.21-5.22). There was no clear temporal trend in the results, and risks were higher in males and varied by MS phenotype.
Conclusions:
Higher hospital admission rates among MS patients for infection are likely to be due to a combination of surveillance bias, cautious medical management and greater susceptibility to severe infections. MS-related functional limitations may increase infection risk and this should be considered in MS management.
Insights
People with multiple sclerosis (MS) face a significantly higher risk of hospital admission for infections. This increased risk is linked to susceptibility, bias, and potentially more severe infections in MS patients.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- Multiple sclerosis (MS) is associated with an elevated risk of infections.
- Understanding factors contributing to infection-related hospital admissions in MS is crucial.
Purpose of the Study:
- To assess the influences of susceptibility, severity, and surveillance bias on infection-related hospital admissions in multiple sclerosis patients.
- To compare infection risk and mortality between MS patients and the general population.
Main Methods:
- Utilized Swedish population registers to identify 20,276 MS patients and 203,951 matched controls.
- Employed Poisson regression to estimate the risk of first hospital admission for infection and mortality over 36 years.
Main Results:
- MS patients exhibited a 4.26-fold increased risk of hospital admission for all infections.
- A higher 1-month mortality rate (RR 4.69) was observed in MS patients post-infection admission.
- Increased risk persisted even when compared to other immune-mediated diseases, suggesting factors beyond bias.
Conclusions:
- Higher infection admission rates in MS are likely due to surveillance bias, cautious management, and increased susceptibility to severe infections.
- MS-related functional limitations may exacerbate infection risk, necessitating consideration in patient management.
- Further research into the interplay of MS, infections, and management strategies is warranted.
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