Ruth Ann Marrie1, Charles N Bernstein2, Christine A Peschken2, Carol A Hitchon2, Hui Chen2, Randy Fransoo2, Allan Garland2. 1. 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. rmarrie@hsc.mb.ca. 2. 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.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.
Authors: Allan Garland; Marina Yogendran; Kendiss Olafson; Damon C Scales; Kari-Lynne McGowan; Randy Fransoo Journal: Med Care Date: 2012-03 Impact factor: 2.983
Authors: Ruth Ann Marrie; Bo N Yu; Stella Leung; Lawrence Elliott; Patricia Caetano; Sharon Warren; Christina Wolfson; Scott B Patten; Lawrence W Svenson; Helen Tremlett; John Fisk; James F Blanchard Journal: Mult Scler Relat Disord Date: 2013-04-02 Impact factor: 4.339
Authors: Marilyn T Haupt; Carolyn E Bekes; Richard J Brilli; Linda C Carl; Anthony W Gray; Michael S Jastremski; Douglas F Naylor; Maria Rudis PharmD; Antoinette Spevetz Md; Suzanne K Wedel; Mathilda Horst Md Journal: Crit Care Med Date: 2003-11 Impact factor: 7.598
Authors: Anush Karamyan; Martin W Dünser; Douglas J Wiebe; Georg Pilz; Peter Wipfler; Vaclav Chroust; Helmut F Novak; Larissa Hauer; Eugen Trinka; Johann Sellner Journal: PLoS One Date: 2016-05-31 Impact factor: 3.240
Authors: Huah Shin Ng; Jonas Graf; Feng Zhu; Elaine Kingwell; Orhan Aktas; Philipp Albrecht; Hans-Peter Hartung; Sven G Meuth; Charity Evans; John D Fisk; Ruth Ann Marrie; Yinshan Zhao; Helen Tremlett Journal: Front Immunol Date: 2022-01-13 Impact factor: 7.561
Authors: Jonas Graf; Huah Shin Ng; Feng Zhu; Yinshan Zhao; José Ma Wijnands; Charity Evans; John D Fisk; Ruth Ann Marrie; Helen Tremlett Journal: Mult Scler Date: 2022-03-01 Impact factor: 5.855
Authors: Seth N Levin; Shruthi Venkatesh; Katie E Nelson; Yi Li; Ines Aguerre; Wen Zhu; Karman Masown; Kathryn T Rimmer; Claudiu I Diaconu; Kaho B Onomichi; Victoria M Leavitt; Libby L Levine; Rebecca Strauss-Farber; Wendy S Vargas; Brenda Banwell; Amit Bar-Or; Joseph R Berger; Andrew D Goodman; Erin E Longbrake; Jiwon Oh; Bianca Weinstock-Guttman; Kiran T Thakur; Keith R Edwards; Claire S Riley; Zongqi Xia; Philip L De Jager Journal: Ann Clin Transl Neurol Date: 2021-02-22 Impact factor: 5.430
Authors: Huah Shin Ng; Feng Zhu; Elaine Kingwell; Yinshan Zhao; Shenzhen Yao; Okechukwu Ekuma; Lawrence W Svenson; Charity Evans; John D Fisk; Ruth Ann Marrie; Helen Tremlett Journal: Mult Scler Date: 2021-12-24 Impact factor: 6.312