A Alshekhlee1, J D Miles, B Katirji, D C Preston, H J Kaminski. 1. Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA. amer.alshekhlee@uhhospitals.org.
Abstract
OBJECTIVE: To determine the incidence and mortality rates and predictors of death in myasthenia gravis (MG) and MG crisis in a large US cohort. METHODS: Our cohort was identified from the Nationwide Inpatient Sample database for the years 2000 through 2005 using ICD-9-CM codes. MG crisis was identified by the principal diagnosis code or by the presence of respiratory failure. The incidence of MG was stratified by age, ethnicity, and gender. Multivariate logistic regression analysis was used to identify predictors of mortality in MG. For trend analyses of immune intervention, we used the Cochrane-Armitage test. RESULTS: After data cleansing, 5,502 patients with MG were included. In women, the incidence of admission was two to three times higher during the first 5 decades. In men, the incidence of admission was higher during the sixth, seventh, and eighth decades. The annual incidence rate of MG was higher in black women (0.01 per 1,000 persons/year) compared to white women and white and black men (0.009, 0.008, and 0.007 per 1,000 persons/year). The overall in-hospital mortality rate was 2.2%, being higher in MG crisis (4.47%). Older age and respiratory failure were the predictors of death, with adjusted odds ratios of 9.28 (95% confidence interval [CI], 3.31, 26.0) and 3.58 (95% CI, 2.01, 6.38). The trend of i.v. immunoglobulin utilization has increased compared to plasma exchange and thymectomy (p < 0.0001). CONCLUSION: Myasthenia gravis (MG) is still a disease of young women and old men, as reflected by the hospital admission rates. In-hospital mortality of MG is low. Hospital utilization of i.v. immunoglobulin has significantly increased compared to plasma exchange and thymectomy.
OBJECTIVE: To determine the incidence and mortality rates and predictors of death in myasthenia gravis (MG) and MG crisis in a large US cohort. METHODS: Our cohort was identified from the Nationwide Inpatient Sample database for the years 2000 through 2005 using ICD-9-CM codes. MG crisis was identified by the principal diagnosis code or by the presence of respiratory failure. The incidence of MG was stratified by age, ethnicity, and gender. Multivariate logistic regression analysis was used to identify predictors of mortality in MG. For trend analyses of immune intervention, we used the Cochrane-Armitage test. RESULTS: After data cleansing, 5,502 patients with MG were included. In women, the incidence of admission was two to three times higher during the first 5 decades. In men, the incidence of admission was higher during the sixth, seventh, and eighth decades. The annual incidence rate of MG was higher in black women (0.01 per 1,000 persons/year) compared to white women and white and black men (0.009, 0.008, and 0.007 per 1,000 persons/year). The overall in-hospital mortality rate was 2.2%, being higher in MG crisis (4.47%). Older age and respiratory failure were the predictors of death, with adjusted odds ratios of 9.28 (95% confidence interval [CI], 3.31, 26.0) and 3.58 (95% CI, 2.01, 6.38). The trend of i.v. immunoglobulin utilization has increased compared to plasma exchange and thymectomy (p < 0.0001). CONCLUSION:Myasthenia gravis (MG) is still a disease of young women and old men, as reflected by the hospital admission rates. In-hospital mortality of MG is low. Hospital utilization of i.v. immunoglobulin has significantly increased compared to plasma exchange and thymectomy.
Authors: Alan E Renton; Hannah A Pliner; Carlo Provenzano; Amelia Evoli; Roberta Ricciardi; Michael A Nalls; Giuseppe Marangi; Yevgeniya Abramzon; Sampath Arepalli; Sean Chong; Dena G Hernandez; Janel O Johnson; Emanuela Bartoccioni; Flavia Scuderi; Michelangelo Maestri; J Raphael Gibbs; Edoardo Errichiello; Adriano Chiò; Gabriella Restagno; Mario Sabatelli; Mark Macek; Sonja W Scholz; Andrea Corse; Vinay Chaudhry; Michael Benatar; Richard J Barohn; April McVey; Mamatha Pasnoor; Mazen M Dimachkie; Julie Rowin; John Kissel; Miriam Freimer; Henry J Kaminski; Donald B Sanders; Bernadette Lipscomb; Janice M Massey; Manisha Chopra; James F Howard; Wilma J Koopman; Michael W Nicolle; Robert M Pascuzzi; Alan Pestronk; Charlie Wulf; Julaine Florence; Derrick Blackmore; Aimee Soloway; Zaeem Siddiqi; Srikanth Muppidi; Gil Wolfe; David Richman; Michelle M Mezei; Theresa Jiwa; Joel Oger; Daniel B Drachman; Bryan J Traynor Journal: JAMA Neurol Date: 2015-04 Impact factor: 18.302
Authors: Gil I Wolfe; Henry J Kaminski; Inmaculada B Aban; Greg Minisman; Hui-Chien Kuo; Alexander Marx; Philipp Ströbel; Claudio Mazia; Joel Oger; J Gabriel Cea; Jeannine M Heckmann; Amelia Evoli; Wilfred Nix; Emma Ciafaloni; Giovanni Antonini; Rawiphan Witoonpanich; John O King; Said R Beydoun; Colin H Chalk; Alexandru C Barboi; Anthony A Amato; Aziz I Shaibani; Bashar Katirji; Bryan R F Lecky; Camilla Buckley; Angela Vincent; Elza Dias-Tosta; Hiroaki Yoshikawa; Márcia Waddington-Cruz; Michael T Pulley; Michael H Rivner; Anna Kostera-Pruszczyk; Robert M Pascuzzi; Carlayne E Jackson; Guillermo S Garcia Ramos; Jan J G M Verschuuren; Janice M Massey; John T Kissel; Lineu C Werneck; Michael Benatar; Richard J Barohn; Rup Tandan; Tahseen Mozaffar; Robin Conwit; Joanne Odenkirchen; Joshua R Sonett; Alfred Jaretzki; John Newsom-Davis; Gary R Cutter Journal: N Engl J Med Date: 2016-08-11 Impact factor: 91.245