Specific factors regarding care in the neurology intensive care unit (ICU) for patients with myasthenia gravis (MG) could predict future complications, according to a study recently published in Neurological Sciences.

This retrospective study included 118 patients previously diagnosed with MG who together experienced 130 severe exacerbations that required admission to the neurology ICU at a single center in Serbia over 14 years. The researchers analyzed all participants’ demographic, clinical, and therapeutic data to identify associations between such features and overall outcomes.

Most of the patients (58.5%) were female, and the median age was 61.5 years.

“Independent predictors of poor outcome in these patients are elder age and prolonged mechanical ventilation,” the authors wrote.

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Older age independently predicted death in this sample. Individuals who died were older on average (72.2±8.7 years) than survivors (55.1±18.9 years). Comorbidities were also associated with lethal outcomes, of which diabetes mellitus was more frequent in the deceased.

Importantly, all patients who died required mechanical ventilation more frequently and received it for a longer period of time than the patients who survived, who required this measure in only 43% of cases. Hence, the study determined that patients with severe exacerbations of MG who did not require mechanical ventilation had good outcomes.

Likewise, 100% of the deceased experienced complications during their stay in the ICU, while only 43% of the survivors did. Overall, complications occurred in 50% of the participants.

Interestingly, up to 20% of admissions to the ICU relied on a medical indication based on somatic complications instead of actual exacerbations.

“This is partially due to the fact that other specialists are always afraid of treating MG patients, and these people are usually referred to neurologists, no matter if they have another threatening disease,” the study authors concluded.

Reference

Zdraljevic M, Peric S, Jeremic M, et al. Myasthenia gravis treated in the neurology intensive care unit: a 14-year single-centre experience. Neurol Sci. Published online September 9, 2022. doi:10.1007/s10072-022-06379-z