From the Departments of Internal Medicine (R.A.M., C.N.B., C.A.P., C.A.H., A.G.) and Community Health Sciences (R.A.M., C.A.P., R.F., A.G.), and IBD Clinical and Research Centre (C.N.B.), University of Manitoba, Winnipeg; and Manitoba Centre for Health Policy (H.C., R.F., A.G.), Winnipeg, Canada.
Neurology. 2014 Jun 10;82(23):2112-9. doi: 10.1212/WNL.0000000000000495. Epub 2014 May 7.
To compare the incidence of, and mortality after, intensive care unit (ICU) admission as well as the characteristics of critical illness in the multiple sclerosis (MS) population vs the general population.
We used population-based administrative data from the Canadian province of Manitoba for the period 1984 to 2010 and clinical data from 93% of admissions to provincial high-intensity adult ICUs. We identified 5,035 prevalent cases of MS and a cohort from the general population matched 5:1 on age, sex, and region of residence. We compared these populations using incidence rates and multivariable regression models adjusting for age, sex, comorbidity, and socioeconomic status.
From January 2000 to October 2009, the age- and sex-standardized annual incidence of ICU admission among prevalent cohorts was 0.51% to 1.07% in the MS population and 0.34% to 0.51% in matched controls. The adjusted risk of ICU admission was higher for the MS population (hazard ratio 1.45; 95% confidence interval [CI] 1.19-1.75) than for matched controls. The MS population was more likely to be admitted for infection than the matched controls (odds ratio 1.82; 95% CI 1.10-1.32). Compared with the matched controls admitted to ICUs, 1-year mortality was higher in the MS population (relative risk 2.06; 95% CI 1.32-3.07) and was particularly elevated in patients with MS who were younger than 40 years (relative risk 3.77; 95% CI 1.45-8.11). Causes of death were MS (9.3%), infections (37.0%), and other causes (52.9%).
Compared with the general population, the risk of ICU admission is higher in MS, and 1-year mortality after admission is higher. Greater attention to preventing infection and managing comorbidity is needed in the MS population.
比较多发性硬化症（MS）人群与普通人群入住重症监护病房（ICU）的发生率和死亡率，以及危重症特征。
我们使用 1984 年至 2010 年加拿大马尼托巴省的基于人群的行政数据和 93%省级成人 ICU 住院患者的临床数据。我们确定了 5035 例 MS 现患病例，并在年龄、性别和居住地区上与普通人群匹配了 5：1 的队列。我们通过发病率和多变量回归模型比较了这些人群，模型中调整了年龄、性别、合并症和社会经济状况。
从 2000 年 1 月至 2009 年 10 月，在 MS 现患队列中，年龄和性别标准化的 ICU 入住年度发生率为 0.51%至 1.07%，在匹配对照组中为 0.34%至 0.51%。与匹配对照组相比，MS 人群 ICU 入住的调整风险更高（风险比 1.45；95%置信区间 [CI] 1.19-1.75）。MS 人群比匹配对照组更有可能因感染而住院（优势比 1.82；95%CI 1.10-1.32）。与入住 ICU 的匹配对照组相比，MS 人群的 1 年死亡率更高（相对风险 2.06；95%CI 1.32-3.07），且年龄小于 40 岁的 MS 患者的死亡率尤其高（相对风险 3.77；95%CI 1.45-8.11）。死亡原因包括 MS（9.3%）、感染（37.0%）和其他原因（52.9%）。
与普通人群相比，MS 人群 ICU 入住风险更高，入住后 1 年死亡率更高。MS 人群需要更加关注预防感染和管理合并症。
