John Garza, PhD
Assistant Professor
University of Texas Permian Basin, United States
Disclosure information not submitted.
Neha Panchagnula
Texas Tech University Health Sciences Center at the Permian Basin
Odessa, Texas
Disclosure information not submitted.
Thao Dang, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
Hina Tariq, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
Lavi Oud, MD
Professor
Texas Tech University Health Sciences Center
Odessa, Texas, United States
Disclosure information not submitted.
Title: The Prognostic Impact of Multiple Sclerosis in Sepsis: a Population-Level Analysis
Introduction: Patients with multiple sclerosis (MS) are at increased risk of sepsis-associated hospitalizations compared to the general population. However, only sparse data were reported on the prognostic impact of MS in sepsis. We sought to estimate the association of MS with short-term mortality in sepsis and to compare the temporal trends of mortality among septic patients with vs without MS.
Methods: We used the Texas Public Use Data File to identify hospitalizations aged ≥18 years with sepsis during 2014-2017. Sepsis was defined by “explicit” ICD-9 and ICD-10 codes for severe sepsis (995.92, R65.20) and septic shock (785.52, R65.21). MS was identified using ICD-9 and ICD-10 codes 340 & G35. Multilevel multivariable logistic regression was used to examine the association of MS with short-term mortality (defined as in-hospital death or discharge to hospice) among sepsis hospitalizations. Similar approach was used to model the temporal trends of short-term mortality among sepsis hospitalizations with and without MS and for sensitivity analyses restricted to ICU admissions and those with septic shock.
Results: Among 283,025 sepsis hospitalizations, 1,778 (0.6%) had MS. Compared to those without MS, MS hospitalizations were younger (age ≥65 years, 34.6% vs 56.8%), more commonly female (67.4% vs. 45.9%), with lower mean [SD] number of failing organs (2.3 [1.4] vs. 2.7 [1.5]) [p< 0.0001 for all comparisons]. The crude short-term mortality among hospitalizations with vs without MS was 19.5% vs 31.3%, respectively. On adjusted analyses, MS remained associated with lower short-term mortality (adjusted odds ratio [aOR] 0.75 [95% CI 0.66-0.86]), with similar findings on sensitivity analyses. The annualized change of short-term mortality among sepsis hospitalizations with MS was not significant (aOR 0.99 [95% CI 0.88-1.12]), but decreased among those without MS (aOR 0.96 [95% CI 0.95-0.97]).
Conclusions: MS was associated, unexpectedly, lower risk of short-term mortality in septic patients. However, the short-term mortality among sepsis hospitalizations with MS changed insignificantly over time, contrasting the trends in those without MS. Additional studies are needed to corroborate these observations, and to determine the sources of the observed associations and the diverging mortality trends.