Moccia Marcello, Affinito Giuseppina, Ronga Bruno, Giordana Roberta, Fumo Maria Grazia, Lanzillo Roberta, Petracca Maria, Carotenuto Antonio, Triassi Maria, Brescia Morra Vincenzo, Palladino Raffaele
Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy.
Department of Public Health, University of Naples Federico II, Naples, Italy.
Mult Scler. 2022 Apr;28(4):597-607. doi: 10.1177/13524585221074010.
Emergency hospital admissions are common in multiple sclerosis (MS), and can highlight unmet medical needs.
To evaluate burden, predictors and outcomes of MS emergency admissions.
This is a population-based study, conducted in the Campania Region (South Italy) from 2015 to 2019, using hospital discharge records, drug prescriptions and outpatients. The risk of emergency hospital admissions and the likelihood of worse outcomes were evaluated using the Cox regression and multinomial logistic regression models, respectively, in relation to age, sex, disease-modifying treatments (DMTs), comorbidities and adherence.
We recorded 1225 emergency admissions for 1001 patients (out of 5765 prevalent MS patients), overall costing 4,143,764.67 EUR. The risk of emergency admissions increased with age (hazard ratio (HR) = 1.02; 95% confidence interval (CI) = 1.01, 1.03; < 0.01) and comorbidities (HR = 1.62; < 0.01), and decreased in patients using DMTs (interferon beta/peg-interferon beta/glatiramer acetate HR = 0.19; < 0.01; teriflunomide/dimethyl-fumarate/fingolimod HR = 0.18; < 0.01, and alemtuzumab/cladribine/natalizumab/ocrelizumab HR = 0.21; < 0.01), and with higher adherence (HR = 0.18; 95% CI = 0.13, 0.26; < 0.01). Following emergency admission, older age was associated with probability of death ( = 63) (odds ratio (OR) = 1.06; < 0.01) and discharge to long-term facility ( = 65) (OR = 1.03; = 0.01).
With 17% people with MS requiring emergency medical care over 5 years, improved management of DMTs and comorbidities could potentially reduce their medical, social and financial burden.
急诊入院在多发性硬化症（MS）患者中很常见，且能凸显未满足的医疗需求。
评估MS急诊入院的负担、预测因素及后果。
这是一项基于人群的研究，于2015年至2019年在坎帕尼亚地区（意大利南部）开展，使用医院出院记录、药物处方和门诊患者数据。分别采用Cox回归模型和多项逻辑回归模型评估急诊入院风险及不良后果发生的可能性，分析对象涉及年龄、性别、疾病修饰治疗（DMTs）、合并症及依从性。
我们记录了1001例患者（来自5765例MS现患患者）的1225次急诊入院情况，总费用为4,143,764.67欧元。急诊入院风险随年龄增长（风险比（HR）=1.02；95%置信区间（CI）=1.01, 1.03；P<0.01）和合并症增加（HR=1.62；P<0.01）而升高，在使用DMTs的患者中降低（干扰素β/聚乙二醇干扰素β/醋酸格拉替雷HR=0.19；P<0.01；特立氟胺/富马酸二甲酯/芬戈莫德HR=0.18；P<0.01，以及阿仑单抗/克拉屈滨/那他珠单抗/奥瑞珠单抗HR=0.21；P<0.01），且依从性越高风险越低（HR=0.18；95%CI=0.13, 0.26；P<0.01）。急诊入院后，年龄较大与死亡概率（n=63）（比值比（OR）=1.06；P<0.01）及转至长期护理机构概率（n=65）（OR=1.03；P=0.01）相关。
5年内17%的MS患者需要急诊医疗护理，改善DMTs和合并症的管理可能会减轻他们的医疗、社会和经济负担。
