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Intensive care due to myasthenia gravis: Risk factors and prognosis
Chris Myllynen1, Anni Tuulasvaara1,2, Sari Atula1,2
1Department of Neurosciences, University of Helsinki, Helsinki, Finland.
Background And Purpose:
Exacerbation of myasthenia gravis (MG) with respiratory failure requires intensive care. We aimed to study the risk factors for intensive care unit admission for MG exacerbation and myasthenic crisis (MC) and the prognosis of people with MG (pwMG) thereafter.
Methods:
This retrospective study investigated patients in the Helsinki and Uusimaa hospital district during the years 2008-2021. PwMG (International Classification of Diseases, 10th revision code G70.0) were identified through a data repository search, followed by a chart review of patient records. Risk factors for intensive care due to MG exacerbation were evaluated as compared with the patients only treated in the outpatient clinic and those treated in the neurological ward for MG exacerbation. The outcomes of patients in intensive care for any reason were also compared with those of patients in intensive care for exacerbation of bronchial asthma.
Results:
Of 577 pwMG, 35 (6.1%) needed intensive care for MG within a median of 5.3 months from diagnosis. The mean (±SD) age at MG diagnosis was higher in the intensive care group (60.5 [±16.1] years) compared to the outpatient (48.3 [±20.9] years; p < 0.001) and neurological ward groups (53.4 [±20.8] years; p = 0.044). Thymoma (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.19-19.43; p = 0.028) and female sex (OR 2.1, 95% CI 1.02-4.48; p = 0.045) were independent risk factors for intensive care. In-hospital mortality was 4% for MC patients. Six-month mortality after intensive care for MG exacerbation (14.3%) was twice that for asthma exacerbation (7.7%).
Conclusion:
Our study shows an increased risk of intensive care treatment for patients with late-onset MG, female sex or thymoma, occurring usually within 6 months from diagnosis, which emphasises the importance of early treatment choices.
Insights
Patients with myasthenia gravis (MG) and respiratory failure requiring intensive care are at higher risk if diagnosed later in life, have thymoma, or are female. Early treatment is crucial for better outcomes.
Area of Science:
- Neurology
- Critical Care Medicine
Background:
- Myasthenia gravis (MG) exacerbation with respiratory failure necessitates intensive care.
- Understanding risk factors and prognosis for intensive care unit (ICU) admission in MG patients is crucial.
Purpose of the Study:
- To identify risk factors for ICU admission in myasthenia gravis patients.
- To evaluate the prognosis of people with MG (pwMG) following ICU admission.
Main Methods:
- Retrospective study of 577 pwMG in the Helsinki and Uusimaa hospital district (2008-2021).
- Analysis of risk factors for ICU admission compared to outpatient and neurological ward treatment.
- Comparison of outcomes for MG patients in ICU versus asthma patients in ICU.
Main Results:
- 6.1% of pwMG required ICU admission, often within 5.3 months of diagnosis.
- Higher age at diagnosis, thymoma, and female sex were independent risk factors for ICU admission.
- In-hospital mortality for myasthenic crisis (MC) was 4%; 6-month mortality post-ICU for MG exacerbation was 14.3%.
Conclusions:
- Late-onset MG, female sex, and thymoma increase the risk of ICU admission.
- These risk factors often manifest within six months of diagnosis.
- Emphasizes the importance of timely and appropriate early treatment choices for pwMG.
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