Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study
Abstract Background Approximately 10% to 20% of myasthenia gravis (MG) patients have experienced a myasthenic crisis (MC), which contributes to morbidity and mortality. MC triggered by infection is associated with poor outcomes. However, there is a lack of prognostic factors that clinicians can util...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-023-03306-3 |
| _version_ | 1827905464487116800 |
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| author | Chia-Yin Chien Chun-Wei Chang Ming-Feng Liao Chun-Che Chu Long-Sun Ro Yih-Ru Wu Kuo-Hsuan Chang Chiung-Mei Chen Hung-Chou Kuo |
| author_facet | Chia-Yin Chien Chun-Wei Chang Ming-Feng Liao Chun-Che Chu Long-Sun Ro Yih-Ru Wu Kuo-Hsuan Chang Chiung-Mei Chen Hung-Chou Kuo |
| author_sort | Chia-Yin Chien |
| collection | DOAJ |
| description | Abstract Background Approximately 10% to 20% of myasthenia gravis (MG) patients have experienced a myasthenic crisis (MC), which contributes to morbidity and mortality. MC triggered by infection is associated with poor outcomes. However, there is a lack of prognostic factors that clinicians can utilize to target interventions for preventing recurrent infection-triggered MC. This study aimed to characterize clinical manifestations, comorbidities, and biochemical profiles associated with recurrent infection-triggered MC in MG patients. Methods This retrospective study included 272 MG patients hospitalized with an infection requiring at least 3 days of antibiotics from January 2001 to December 2019. Patients were further stratified into non-recurrent or recurrent infection groups. Clinical features such as gender, age, concomitant diseases, acetylcholine receptor antibodies and biochemical data (including electrolytes and coagulants), muscle strength of pelvic and shoulder girdle, bulbar and respiratory function, management with an endotracheal tube, Foley catheter, or plasmapheresis, duration of hospitalization, and culture pathogens were recorded. Results The recurrent infection group was significantly older than the non-recurrent group (median age, 58.5 versus 52.0 years). Pneumonia was the most common infection and Klebsiella pneumoniae was the most common pathogen. The presence of concomitant diabetes mellitus, activated partial thromboplastin time prolongation, the duration of hospitalization, and hypomagnesaemia were independently associated with recurrent infection. The presence of deep vein thrombosis, thymic cancer, and electrolyte imbalances i.e., hypokalemia, and hypoalbuminemia were significantly associated with a risk for infection. The influence of endotracheal intubation, anemia, and plasmapheresis during hospitalization were inconsistent. Conclusions The independent risk factors for recurrent infections in MG patients identified in this study include the presence of concomitant diabetes mellitus, hypomagnesaemia, activated partial thromboplastin time prolongation, and longer duration of hospitalization, highlighting the need for targeted interventions to prevent recurrent infections in this population. Further research and prospective studies are warranted to validate these findings and refine interventions for optimizing patient care. |
| first_indexed | 2024-03-13T00:42:02Z |
| format | Article |
| id | doaj.art-da996c3067b8406d98d162c4d43cdc6d |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-03-13T00:42:02Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-da996c3067b8406d98d162c4d43cdc6d2023-07-09T11:17:10ZengBMCBMC Neurology1471-23772023-07-0123111110.1186/s12883-023-03306-3Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort studyChia-Yin Chien0Chun-Wei Chang1Ming-Feng Liao2Chun-Che Chu3Long-Sun Ro4Yih-Ru Wu5Kuo-Hsuan Chang6Chiung-Mei Chen7Hung-Chou Kuo8Department of Neurology, Chang Gung Memorial Hospital Linkou Medical CentreDepartment of Neurology, Chang Gung Memorial Hospital Linkou Medical CentreDepartment of Neurology, Chang Gung Memorial Hospital Linkou Medical CentreDepartment of Neurology, Chang Gung Memorial Hospital Linkou Medical CentreDepartment of Neurology, Chang Gung Memorial Hospital Linkou Medical CentreDepartment of Neurology, Chang Gung Memorial Hospital Linkou Medical CentreDepartment of Neurology, Chang Gung Memorial Hospital Linkou Medical CentreDepartment of Neurology, Chang Gung Memorial Hospital Linkou Medical CentreDepartment of Neurology, Chang Gung Memorial Hospital Linkou Medical CentreAbstract Background Approximately 10% to 20% of myasthenia gravis (MG) patients have experienced a myasthenic crisis (MC), which contributes to morbidity and mortality. MC triggered by infection is associated with poor outcomes. However, there is a lack of prognostic factors that clinicians can utilize to target interventions for preventing recurrent infection-triggered MC. This study aimed to characterize clinical manifestations, comorbidities, and biochemical profiles associated with recurrent infection-triggered MC in MG patients. Methods This retrospective study included 272 MG patients hospitalized with an infection requiring at least 3 days of antibiotics from January 2001 to December 2019. Patients were further stratified into non-recurrent or recurrent infection groups. Clinical features such as gender, age, concomitant diseases, acetylcholine receptor antibodies and biochemical data (including electrolytes and coagulants), muscle strength of pelvic and shoulder girdle, bulbar and respiratory function, management with an endotracheal tube, Foley catheter, or plasmapheresis, duration of hospitalization, and culture pathogens were recorded. Results The recurrent infection group was significantly older than the non-recurrent group (median age, 58.5 versus 52.0 years). Pneumonia was the most common infection and Klebsiella pneumoniae was the most common pathogen. The presence of concomitant diabetes mellitus, activated partial thromboplastin time prolongation, the duration of hospitalization, and hypomagnesaemia were independently associated with recurrent infection. The presence of deep vein thrombosis, thymic cancer, and electrolyte imbalances i.e., hypokalemia, and hypoalbuminemia were significantly associated with a risk for infection. The influence of endotracheal intubation, anemia, and plasmapheresis during hospitalization were inconsistent. Conclusions The independent risk factors for recurrent infections in MG patients identified in this study include the presence of concomitant diabetes mellitus, hypomagnesaemia, activated partial thromboplastin time prolongation, and longer duration of hospitalization, highlighting the need for targeted interventions to prevent recurrent infections in this population. Further research and prospective studies are warranted to validate these findings and refine interventions for optimizing patient care.https://doi.org/10.1186/s12883-023-03306-3Myasthenia gravisMyasthenic crisisReinfectionRisk factorsDiabetes mellitus |
| spellingShingle | Chia-Yin Chien Chun-Wei Chang Ming-Feng Liao Chun-Che Chu Long-Sun Ro Yih-Ru Wu Kuo-Hsuan Chang Chiung-Mei Chen Hung-Chou Kuo Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study BMC Neurology Myasthenia gravis Myasthenic crisis Reinfection Risk factors Diabetes mellitus |
| title | Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study |
| title_full | Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study |
| title_fullStr | Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study |
| title_full_unstemmed | Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study |
| title_short | Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study |
| title_sort | myasthenia gravis and independent risk factors for recurrent infection a retrospective cohort study |
| topic | Myasthenia gravis Myasthenic crisis Reinfection Risk factors Diabetes mellitus |
| url | https://doi.org/10.1186/s12883-023-03306-3 |
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