Background:
Little is known about the risk of intensive care unit (ICU) admission in the nonelderly MS population and health outcomes following admission. It has been previously shown that MS is linked to increased risks of infection and heart disease, which could increase the risk of being admitted to the ICU. It is important to have knowledge pertaining to ICU admissions in the MS population for the benefit of health care professionals and MS patients alike.
An MS Society supported study led by Dr. Donald Paty Career Development award recipient Dr. Ruth Ann Marrie and colleagues examined the incidence of ICU admission in the MS population compared to the general population in Manitoba. In addition they looked at reasons for ICU admission and mortality after ICU admission.
The Study:
In order to better understand the relationship between MS and admission to the ICU, Dr. Marrie and colleagues collected anonymized provincial administrative data, which allowed them to identify over 5,000 Manitobans with MS as well as members of the general population who shared similar characteristics (controls), and clinical data from the Winnipeg Regional Health Authority’s ICU database which represents 93% of admissions to adult ICUs in the province. The research team also investigated the characteristics of critical illness in the MS group to determine the primary reasons for ICU admission and severity of presentation. They hypothesized that individuals with MS have increased rates of ICU admission and death following admission. They also proposed that infections would be the most common reason for increased ICU admissions.
Results:
The study found that risk of ICU admission is higher in the MS population than the general population. Specifically, 4.3% of the MS population studied was admitted to the ICU, compared to 2.4% of the matched controls from the general population. Researchers also noted that people with MS were younger on average than the general population when admitted to the ICU.
Data revealed that mortality was 2-fold higher one year after ICU admission in the MS group compared to controls. Mortality was particularly higher in younger people with MS (18-39 years of age). The MS group was more likely to be admitted for infection than the general population, as hypothesized by the researchers.
Comment:
The results from this MS Society supported study add to a limited body of data on the frequency of, and reasons for, ICU admission in people with MS. The increased risk of ICU admission and mortality following admission reported in people with MS, especially among young persons, highlights the need for increased attention directed towards preventing infections and managing co-occurring conditions in the MS population in order to reduce these outcomes. Since this study did not include data pertaining to the clinical course and disability status of the MS population, further research will be required to evaluate how those factors impact the risk of ICU admission. Finally, this study paves a path for further research to assess ICU admissions in people not only in Manitoba but across the county.
Source:
Marrie RA et al. Intensive care unit admission in multiple sclerosis. Neurology 2014 June 10; 82(23): 2112-2119.