■肌无力危象(MC)是重症肌无力(MG)的一种危及生命的疾病。治疗性血浆置换(TPE)和静脉注射免疫球蛋白(IVIg)可有效治疗MC患者。然而,不是每个MC都对抢救疗法反应良好,并且仍然缺乏前瞻性队列证据的结局决定因素。
■探讨MC患者院内转归的危险因素。
■使用基于国家神经肌肉中心的MG队列,从危机到危机后阶段进行前瞻性随访,我们最终纳入了接受标准抢救治疗方案的76例独立患者的90例MC发作.
■平均入院年龄为52.89±15.72岁。女性占63.16%(48/76),胸腺瘤相关MG(TMG)占63.16%(48/76),住院总死亡率为2.63%(2/76),使用机械通气(MV)的平均持续时间为17.09±13.36天(0~53天).与抗乙酰胆碱受体(AChR)抗体的患者相比,肌肉特异性酪氨酸激酶(MuSK)相关的MC表现出更短的MV支持(5.20±5.07对17.40±13.24天,p=0.023),重症监护病房(ICU)住院时间(6.00±4.64天与19.16±17.54天,p=0.046),住院时间(16.00±4.12与34.43±20.48天,p=0.011)。胸腺瘤[优势比(OR):0.200,95%置信区间(CI):0.058-0.687,p=0.011],MV前血气中二氧化碳分压(PCO2)(OR:1.238,95%CI:1.015-1.510,p=0.035),和肺炎(OR:0.204,95%CI:0.049-0.841,p=0.028)被确定为长期使用MV的独立危险因素。具有胸腺瘤负担的TMG患者表现出明显的更长的MV使用(22.08±17.54对8.88±6.79天,p=0.001),住院时间延长(40.40±26.13对23.67±13.83天,p=0.009)与非TMG相比。即使完全切除胸腺瘤(R0),TMG与非TMG相比表现出不利的结果。
■通过及时的抢救治疗和前瞻性随访,MC的院内结局有了显著改善.胸腺瘤,MV前血气中的PCO2,和肺炎被确定为长期使用MV的独立危险因素。
肌无力危象住院结局的危险因素肌无力危象(MC)是重症肌无力(MG)的一种危及生命的疾病。治疗性血浆置换(TPE)和静脉注射免疫球蛋白(IVIg)可有效治疗MC患者。然而,不是每个MC都对抢救疗法反应良好,并且仍然缺乏前瞻性队列证据的结局决定因素。使用基于国家神经肌肉中心的MG队列,从危机到危机后阶段进行前瞻性随访,我们纳入了接受标准抢救治疗方案的76例独立患者的90例MC发作.平均入院年龄为52.89±15.72岁。女性占主导地位,胸腺瘤相关MG比例高。总体住院死亡率为2.63%(2/76),使用MV的平均持续时间为17.09±13.36天(0-53天)。与具有抗AChR抗体的患者相比,与MuSK相关的MC表现出更短的MV支持,ICU住院时间和住院时间。胸腺瘤,MV前血气中的PCO2,和肺炎被确定为长期使用MV的独立危险因素。具有胸腺瘤负担的TMG患者表现出明显的更长的MV使用,与非TMG相比,住院时间延长。即使完全切除胸腺瘤(R0),TMG与非TMG相比表现出不利的结果。通过及时的抢救治疗和前瞻性的随访,MC的院内结局有了显著改善.胸腺瘤,MV前血气中的PCO2,和肺炎。
UNASSIGNED: Myasthenic crisis (MC) is a life-threatening condition for myasthenia gravis (MG). Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) efficaciously treat patients with MC. However, not every MC responds well to rescue therapies, and the determinants for outcome with the evidence from prospective cohorts are still lacking.
UNASSIGNED: To explore the risk factors for in-hospital outcomes in patients with MC.
UNASSIGNED: Using a national neuromuscular center-based cohort of MG with prospective follow-ups from the crisis to the post-crisis phase, we finally included 90 MC episodes from 76 independent patients who received a standard regimen of rescue therapies.
UNASSIGNED: The mean admission age was 52.89 ± 15.72 years. With a female predominance of 63.16% (48/76) and a high proportion of thymoma-associated MG (TMG) of 63.16% (48/76), the overall in-hospital mortality was 2.63% (2/76) and the average duration for mechanical ventilation (MV) use was 17.09 ± 13.36 days (0-53 days). In contrast to the patients with anti-acetylcholine receptor (AChR) antibodies, muscle-specific tyrosine kinase (MuSK)-associated MC exhibited a shorter MV support (5.20 ± 5.07 versus 17.40 ± 13.24 days, p = 0.023), length of intensive care units (ICU) stay (6.00 ± 4.64 versus 19.16 ± 17.54 days, p = 0.046), and hospital stay (16.00 ± 4.12 versus 34.43 ± 20.48 days, p = 0.011). Thymoma [odds ratio (OR): 0.200, 95% confidence interval (CI): 0.058-0.687, p = 0.011], partial pressure of carbon dioxide (PCO2) in blood gas before MV (OR: 1.238, 95% CI: 1.015-1.510, p = 0.035), and pneumonia (OR: 0.204, 95% CI: 0.049-0.841, p = 0.028) were identified as independent risk factors for prolonged MV use. TMG patients with thymoma burden exhibited a notable longer MV use (22.08 ± 17.54 versus 8.88 ± 6.79 days, p = 0.001), a prolonged hospital stay (40.40 ± 26.13 versus 23.67 ± 13.83 days, p = 0.009) compared with non-TMG. Even with complete thymoma resection (R0), TMG exhibited an unfavorable outcome versus non-TMG.
UNASSIGNED: With timely rescue therapies and prospective follow-ups, the in-hospital outcome of MCs was substantially improved. Thymoma, PCO2 in blood gas before MV, and pneumonia were identified as independent risk factors for prolonged MV use.
Risk factors for in-hospital outcome of myasthenic crisis Myasthenic crisis (MC) is a life-threatening condition for myasthenia gravis (MG). Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) efficaciously treat patients with MC. However, not every MC responds well to rescue therapies, and the determinants for outcome with the evidence from prospective cohorts are still lacking. Using a national neuromuscular center-based cohort of MG with prospective follow-ups from the crisis to the post-crisis phase, we were able to include 90 MC episodes from 76 independent patients who received a standard regimen of rescue therapies. The mean admission age was 52.89±15.72 years. With a female predominance and a high proportion of thymoma-associated MG. The overall in-hospital mortality was 2.63% (2/76) and the average duration for MV use was 17.09±13.36 days (0-53 days). In contrast to the patients with anti-AChR antibodies, MuSK-associated MC exhibited a shorter MV support, length of ICU stay and hospital stay. Thymoma, PCO2 in blood gas before MV, and pneumonia were identified as independent risk factors for prolonged MV use. TMG patients with thymoma burden exhibited a notable longer MV use, a prolonged hospital stay compared with non-TMG. Even with complete thymoma resection (R0), TMG exhibited an unfavorable outcome versus non-TMG. With timely rescue therapies and prospective follow-ups, the in-hospital outcome of MCs was substantially improved. Thymoma, PCO2 in blood gas before MV, and pneumonia.