Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis
Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis
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DOI：
10.1001/jamaneurol.2020.2581
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发表时间：
2020-09-01
期刊：
影响因子：
29
通讯作者：
De Seze, Jerome
中科院分区：
文献类型：
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作者：
Louapre, Celine;Collongues, Nicolas;De Seze, Jerome
与多发性硬化症(MS)患者2019年冠状病毒病(新冠肺炎)严重程度相关的重要风险因素尚不清楚。除了年龄和合并症等已确定的风险因素外，疾病修改疗法(DMT)还可以修改发展为严重新冠肺炎感染的风险。目的描述多发性硬化合并新冠肺炎的临床特点和转归，并找出与新冠肺炎严重程度相关的因素。设计、设置和参与者Covisep注册是一项在多发性硬化症专家中心和综合医院以及神经学家与多发性硬化症专家中心和法国硬化症斑块协会成员合作的多中心、回溯性、观察性队列研究。这项研究包括2020年3月1日至2020年5月21日期间确诊或高度怀疑患有新冠肺炎的多发性硬化症患者。接触新冠肺炎是通过鼻咽拭子聚合酶链式反应测试、胸部计算机断层扫描或典型症状诊断的。主要结果和指标主要结果是新冠肺炎的严重程度按7分顺序评分(从1分[没有住院，活动没有限制]到7分[死亡])，截止时间为3分(住院且不需要补充氧气)。我们收集了人口统计学、神经病史、扩展残疾严重程度量表评分(EDSS；范围从0到10，以3和6为界)、合并症、新冠肺炎特征和结果。使用单变量和多变量Logistic回归模型来估计收集到的变量与新冠肺炎结果的相关性。结果共分析347例患者(平均年龄44.6[12.8]岁，女性249例；平均病程13.5[10.0]年)。73例患者(21.0%)新冠肺炎严重程度评分在3分或以上，12例患者(3.5%)死于新冠肺炎。中位数EDSS为2.0(范围0-9.5)，284例(81.8%)接受DMT治疗。与接受DMT的患者相比，没有DMT的患者中新冠肺炎严重程度评分为3或更高的患者比例更高(46.0%比15.5%；P<；.001)。多因素Logistic回归模型确定了年龄(每10年的优势比：1.9[95%CI，1.4-2.5])、EDSS(EDSS和GT；=6，6.3[95%CI])。和肥胖(OR，3.0[95%CI，1.0~8.7])是新冠肺炎严重程度评分等于或大于3(表示住院或严重程度更高)的独立危险因素。抑郁自评量表与新冠肺炎严重预后的变异性最大(R-2，0.2)，其次是年龄(R-2，0.06)和肥胖(R-2，0.01)。在这项基于注册的队列研究中，MS患者的结论和相关性、年龄、EDSS和肥胖是严重新冠肺炎的独立危险因素；未发现DMT暴露与新冠肺炎严重程度之间的关联。这些危险因素的识别应该为新冠肺炎期间多发性硬化症患者的临床管理提供个人策略的基础。问题：哪些危险因素会导致多发性硬化症(MS)患者发展为严重的2019年冠状病毒病(新冠肺炎)？在这项对347名MS患者的队列研究中，发现严重形式的新冠肺炎的危险因素是神经功能障碍、年龄和肥胖，但没有发现疾病修饰疗法暴露和新冠肺炎严重程度之间的关联。这意味着识别这些危险因素可以为新冠肺炎期间多发性硬化症患者的临床管理提供个体化策略的依据。这项队列研究描述了患有新冠肺炎的多发性硬化症患者的临床特征和结果，并确定了与新冠肺炎严重程度相关的因素。
Importance Risk factors associated with the severity of coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (MS) are unknown. Disease-modifying therapies (DMTs) may modify the risk of developing a severe COVID-19 infection, beside identified risk factors such as age and comorbidities. Objective To describe the clinical characteristics and outcomes in patients with MS and COVID-19 and identify factors associated with COVID-19 severity. Design, Setting, and Participants The Covisep registry is a multicenter, retrospective, observational cohort study conducted in MS expert centers and general hospitals and with neurologists collaborating with MS expert centers and members of the Societe Francophone de la Sclerose en Plaques. The study included patients with MS presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and May 21, 2020. Exposures COVID-19 diagnosed with a polymerase chain reaction test on a nasopharyngeal swab, thoracic computed tomography, or typical symptoms. Main Outcomes and Measures The main outcome was COVID-19 severity assessed on a 7-point ordinal scale (ranging from 1 [not hospitalized with no limitations on activities] to 7 [death]) with a cutoff at 3 (hospitalized and not requiring supplemental oxygen). We collected demographics, neurological history, Expanded Disability Severity Scale score (EDSS; ranging from 0 to 10, with cutoffs at 3 and 6), comorbidities, COVID-19 characteristics, and outcomes. Univariate and multivariate logistic regression models were used to estimate the association of collected variables with COVID-19 outcomes. Results A total of 347 patients (mean [SD] age, 44.6 [12.8] years, 249 women; mean [SD] disease duration, 13.5 [10.0] years) were analyzed. Seventy-three patients (21.0%) had a COVID-19 severity score of 3 or more, and 12 patients (3.5%) died of COVID-19. The median EDSS was 2.0 (range, 0-9.5), and 284 patients (81.8%) were receiving DMT. There was a higher proportion of patients with a COVID-19 severity score of 3 or more among patients with no DMT relative to patients receiving DMTs (46.0% vs 15.5%; P < .001). Multivariate logistic regression models determined that age (odds ratio per 10 years: 1.9 [95% CI, 1.4-2.5]), EDSS (OR for EDSS >= 6, 6.3 [95% CI. 2.8-14.4]), and obesity (OR, 3.0 [95% CI, 1.0-8.7]) were independent risk factors for a COVID-19 severity score of 3 or more (indicating hospitalization or higher severity). The EDSS was associated with the highest variability of COVID-19 severe outcome (R-2, 0.2), followed by age (R-2, 0.06) and obesity (R-2, 0.01). Conclusions and Relevance In this registry-based cohort study of patients with MS, age, EDSS, and obesity were independent risk factors for severe COVID-19; there was no association found between DMTs exposure and COVID-19 severity. The identification of these risk factors should provide the rationale for an individual strategy regarding clinical management of patients with MS during the COVID-19 pandemic.Question What are the risk factors for developing a severe form of coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (MS)? Findings In this cohort study of 347 patients with MS, risk factors for severe forms of COVID-19 were neurological disability, age, and obesity, but no association was found between disease-modifying therapies exposure and COVID-19 severity. Meaning The identification of these risk factors could provide a rationale for an individual strategy of clinical management in patients with MS during the COVID-19 pandemic.This cohort study describes the clinical characteristics and outcomes in patients with multiple sclerosis who contract COVID-19 and identifies factors associated with COVID-19 severity.