For example, they found increased hospitalization risks among patients taking rituximab (4.5 times) or ocrelizumab (1.63 times). Glucocorticoid use, too, was associated with higher risks of both hospitalization (2.0 hours) and death (4.0 hours) if it occurred in the 2 months prior to COVID-19 diagnosis.
The cross-sectional study based on their record included anonymous data about 1626 patients with MS (average [SD] age, 47.7 [13.2] year), of which 82.7% were laboratory-confirmed cases of SARS-CoV-2 infection (the virus that causes COVID-19 infection); nearly half of the patients (49.5%) had 1 or more comorbidities (most common: hip tolerance, 22.0%; morbid obesity, 11.0%; diabetes, 9.1%).
Data from 47 states, Puerto Rico, 4 Canadian provinces, and Mexico were provided with the COVID-19 Diseases in MS Registry for North America for April 1 to December 12, 2020. Eighty percent of the patients with recurrent MS, 74.0% were female, and 61.5% were white non-Hispanic.
Clinical outcomes were assessed as they related to 4 stages of acute disease: non-hospital, hospital-only, admission to the intensive care unit (ICU) and / or essential shower support, and death.
An overall mortality rate of 3.3% (95% CI, 2.5% –4.3%) was observed among patients with MS comorbid and COVID-19, of which 79.6% were hospitalized, 53.7% required. had access to ICU, and required 46.3% shower support. Male sex and being black alone were associated with 41% and 47% more, respectively, of hospital alone, while “old age, obesity, and several cardiovascular abilities were associated with COVID-19 more hard, ”the authors noted.
More severe side effects for mobility disability and old age (every 10 years) were evident across all stages of disease above that were not hospitalized:
- Mobile disability:
- The risk was 2.8 (95% CI, 1.6–4.8) times higher in hospital alone
- 3.5 (95% CI, 1.6-7.8) times greater chance of accessing the ICU / requiring shower support
- The risk of death was 25.4 (95% CI, 9.3–69.1) times higher
- Age:
- The risk was 1.3 (95% CI, 1.1–1.6) times greater in hospital alone
- 1.3 (95% CI, 0.99-1.7) times greater chance of accessing the ICU / requiring shower support
- The risk of death was 1.8 (95% CI, 1.2–2.6) times higher
When broken down by age group, the risk of mortality with old age becomes even more pronounced: 35 to 44 years, 1.2% (95% CI, 0.4% -25.9%); 45 to 54 years, 2.1% (95% CI, 1.0% –4.0%); 55 to 64 years, 4.9% (95% CI, 2.8% – 7.8%); 65 to 74 years, 11.7% (95% CI, 7.0% -18.1%); and 75 years or older, 22.6% (95% CI, 9.6% –41.1%).
“For every 10-year increase in age, there was a 30% increased risk of both hospital-only and ICU admission and / or ventilation,” the authors said. “Notably, for every 10-year increase, the risk of death was 76.5% greater.”
Studies also revealed high levels of COVID-19 symptoms in the study patients reporting fever as their main symptom (n = 878; 55%):
- Dry cough: 39.2%
- Fatigue: 40.4%
- Anosmia: 26%
- Ageusia: 25.3%
- Pain: 25.6%
- Headache: 25.7%
Neurological symptoms were reported for 8.9% of patients also reporting fever and mainly including motor dysfunction (44.4%) and cognitive dysfunction (25.7%). Overall, symptoms typically lasted 7 to 13 (27.7%) or 14 to 20 days (27.6%) among patients reporting COVID-19 symptoms.
The authors note that some of their findings run counter to prior studies, so these patients should be closely monitored and their findings informed. confirmed by future studies.
“No clear link of the diagnosis of MS with the risk of developing COVID-19 could be established in this study due to the unknown risk factors in the MS numbers from which reporting issues, ”the authors concluded. “However, with more than 1600 patients with MS, the COViMS Table provides evidence that ambulation disability, old age, and Black race associated with the clinical course of COVID-19 are worse in the North American MS population. Knowledge of these risk factors may enable clinicians for patients with MS to improve the diagnosis and treatment of COVID-19.
Information
Salter A, Fox RJ, Newsome SD, et al. Outcomes and risk factors associated with SARS-CoV-2 infection in the North American register of patients with multiple sclerosis. JAMA Neurol. Published online 19 March 2021. doi: 10.1001 / jamaneurol.2021.0688