Pirttisalo Anna-Leena, Sipilä Jussi O T, Viitala Matias, Soilu-Hänninen Merja
Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland; Department of Clinical Neurosciences, University of Turku, Turku, Finland.
Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland; Department of Clinical Neurosciences, University of Turku, Turku, Finland; Department of Neurology, Siun sote, North Karelia Central Hospital, Joensuu, Finland.
Mult Scler Relat Disord. 2020 Sep;44:102328. doi: 10.1016/j.msard.2020.102328. Epub 2020 Jun 23.
Multiple sclerosis (MS) patients are at increased risk for infections. The aim of this study was to investigate the trends in hospital admissions of patients with MS and to identify the factors predisposing to infection-related admissions.
Hospital admissions with MS as a primary or an auxiliary diagnosis in the hospital district of Southwest Finland in 2009-2018 were searched and MS patients with infection admissions compared with other MS patients in the hospital district. Data were derived from hospital registries, patient charts and the Finnish MS register. Group comparisons were performed using Pearson´s chi-squared test, Fisher´s exact test or Wilcoxon rank sum test. Overdispersion-adjusted Poisson regression was used to analyze the annual admission numbers and multivariable logistic regression to examine the predictors of infection-related admissions.
1380 hospital admissions for 532 patients were identified. The annual number of admissions decreased by 8.9% annually (p<0.001). Proportion of infection-related admissions declined from 26.5% to 19.5% (p = 0.049). The patients with infection admissions were on average 8.2 years older (p<0.001), more often male (p<0.001), had on average 5.3 years longer disease duration (p<0.001), more disability (median EDSS 5.0 vs. 2.0; p<0.001), more often progressive disease (p<0.001) and more comorbidities (p = 0.006) than other MS patients. Disease modifying therapies (DMTs) were used less often by patients with infection admissions (p<0.001). Infection admissions were not associated with the number of recent relapses. In-hospital mortality was higher in the infection-related admissions (3.57% vs 0.29%; p<0.001). Only 14.3% of patients with over two infection admissions had a DMT during the study period.
Hospital admissions, with or without an infection, have become more infrequent in MS patients of Southwest Finland over the decade from 2009 to 2018. Infection-related admissions were associated with lesser use of DMTs, older age, male gender and disability.
多发性硬化症（MS）患者感染风险增加。本研究旨在调查MS患者的住院趋势，并确定导致感染相关住院的因素。
检索2009 - 2018年芬兰西南部医院区以MS作为主要或辅助诊断的住院病例，并将感染住院的MS患者与该医院区的其他MS患者进行比较。数据来自医院登记处、患者病历和芬兰MS登记册。采用Pearson卡方检验、Fisher精确检验或Wilcoxon秩和检验进行组间比较。使用过分散调整的泊松回归分析年度住院人数，使用多变量逻辑回归分析感染相关住院的预测因素。
共识别出532例患者的1380次住院。住院人数每年下降8.9%（p<0.001）。感染相关住院的比例从26.5%降至19.5%（p = 0.049）。与其他MS患者相比，感染住院患者平均年龄大8.2岁（p<0.001），男性更多（p<0.001），疾病持续时间平均长5.3年（p<0.001），残疾程度更高（EDSS中位数5.0对2.0；p<0.001），更常为进展性疾病（p<0.001）且合并症更多（p = 0.006）。感染住院患者较少使用疾病修正疗法（DMTs）（p<0.001）。感染住院与近期复发次数无关。感染相关住院的院内死亡率更高（3.57%对0.29%；p<0.001）。在研究期间，超过两次感染住院的患者中只有14.3%使用了DMTs。
在2009年至2018年的十年间，芬兰西南部MS患者的住院（无论有无感染）变得更加不常见。感染相关住院与较少使用DMTs、年龄较大、男性和残疾有关。
