Myasthenic crisis treated in a Chinese neurological intensive care unit: clinical features, mortality, outcomes, and predictors of survival.

BACKGROUND

Myasthenic crisis (MC) often requires admission to an intensive care unit (ICU).

METHODS

We retrospectively investigated 113 consecutive patients with first MC admitted to the neurological ICU. Patients' demographic, clinical and other characteristics were examined, as well as therapeutic interventions, mortality and functional outcome.

RESULTS

MC patients at first onset admitted to neurological ICU had a mortality rate of 18.6%. PCO level before intubation and score on Myasthenia Gravis-Activities of Daily Living (MG-ADL) scale at MC onset correlated with duration of ventilation and length of ICU stay. Compared with patients with good functional outcome, patients with intermediate or poor functional outcome were older at first MC onset, had lower pH and PO, and had higher PCO before intubation. Multivariate logistic analysis identified pre-intubation PCO level as an independent predictor of survival. Cox regression showed that age at first MC onset requiring ICU management was the factor which significantly influenced the mortality.

CONCLUSIONS

Our results suggest that PCO before intubation and MG-ADL score at MC onset may be useful indicators of more severe disease likely to require extensive respiratory support and ICU management. Higher pre-intubation PCO indicates chronic respiratory acidosis that can increase risk of severe disability and death, especially in patients with older age at first MC onset.