背景:尽管某些患有多发性硬化症(MS)的亚组患者,一种免疫介导的疾病,与普通人群相比,急性COVID-19预后较差的风险更高,目前尚不清楚与未感染COVID-19的MS患者相比,SARS-CoV-2感染是否会影响长期结局.
目的:本研究调查了SARS-CoV-2感染后3.5年的MS疾病活动性和死亡率,并与无COVID-19的MS患者进行了比较。
方法:这项回顾性研究评估了2016年1月至2023年7月在布朗克斯的蒙特菲奥雷卫生系统中的1,633名MS患者。该卫生系统为大量少数民族人口提供服务,是早期大流行和随后的感染激增的中心。通过阳性聚合酶链反应测试确定SARS-CoV-2感染阳性。主要结果是全因死亡率,SARS-CoV-2感染后视神经炎。次要结局包括改变疾病改善治疗(DMT),用大剂量甲基强的松龙治疗,小脑缺陷,复发,以及感染后全因住院。
结果:患有COVID-19的MS患者具有相似的人口统计学特征,但先前存在的主要合并症的患病率更高(高血压,2型糖尿病,慢性阻塞性肺疾病,充血性心力衰竭,慢性肾病,和冠状动脉疾病),视神经炎,与没有COVID-19的MS患者相比,高剂量类固醇治疗复发的病史。患有COVID-19的MS患者的死亡风险更高(调整后的HR=4.34[1.67,11.30],p<0.005),感染后视神经炎的风险更大(调整后的HR=2.97[1.58,5.58],p<0.005),甲基强的松龙治疗感染后急性复发的发生率更高(12.65%vs.2.54%,p<0.001),和更多的住院(78.92%vs.66.81%,p<0.01),与无COVID-19的MS患者相比。
结论:在COVID-19感染中幸存的MS患者的长期预后较差,通过治疗复发来衡量,住院和死亡率。确定长期预后较差的危险因素可能会引起临床注意,需要对SARS-CoV-2感染后的高危人群进行仔细的随访。
BACKGROUND: Although certain subsets patients with multiple sclerosis (MS), an immune-mediated disorder, are at higher risk of worse acute COVID-19 outcomes compared to the general population, it is not clear whether SARS-CoV-2 infection impacts long-term outcomes compared with MS patients without COVID-19 infection.
OBJECTIVE: This study investigated MS disease activity and mortality 3.5 years post SARS-CoV-2 infection and compared with MS patients without COVID-19.
METHODS: This retrospective study evaluated 1,633 patients with MS in the Montefiore Health System in the Bronx from January 2016 to July 2023. This health system serves a large minority population and was an epicenter for the early pandemic and subsequent surges of infection. Positive SARS-CoV-2 infection was determined by a positive polymerase-chain-reaction test. Primary outcomes were all-cause mortality, and optic neuritis post SARS-CoV-2 infection. Secondary outcomes included change in disease-modifying therapy (DMT), treatment with high-dose methylprednisolone, cerebellar deficits, relapse, and all-cause hospitalization post-infection.
RESULTS: MS patients with COVID-19 had similar demographics but higher prevalence of pre-existing major comorbidities (hypertension, type-2 diabetes, chronic obstructive pulmonary disease, congestive heart failure, chronic kidney disease, and coronary artery disease), optic neuritis, and history of high dose steroid treatment for relapses compared to MS patients without COVID-19. MS patients with COVID-19 had greater risk of mortality (adjusted HR=4.34[1.67, 11.30], p < 0.005), greater risk of post infection optic neuritis (adjusted HR=2.97[1.58, 5.58], p < 0.005), higher incidence of methylprednisolone treatment for post infection acute relapse (12.65% vs. 2.54 %, p < 0.001), and more hospitalization (78.92% vs. 66.81 %, p < 0.01), compared to MS patients without COVID-19.
CONCLUSIONS: MS patients who survived COVID-19 infection experienced worse long-term outcomes, as measured by treatment for relapse, hospitalization and mortality. Identifying risk factors for worse long-term outcomes may draw clinical attention to the need for careful follow-up of at-risk individuals post-SARS-CoV-2 infection.