Comorbidity in multiple sclerosis: its temporal relationships with disease onset and dose effect on mortality
Comorbidity in multiple sclerosis: its temporal relationships with disease onset and dose effect on mortality
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DOI：
10.1111/ene.14040
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发表时间：
2019-07-31
影响因子：
5.1
通讯作者：
Whitehouse, W. P.
中科院分区：
文献类型：
--
作者：
Chou, I. J.;Kuo, C. F.;Whitehouse, W. P.
背景和目的 我们的目的是确定多发性硬化症 (MS) 诊断时合并症的负担、诊断后出现新合并症的风险以及合并症对 MS 患者死亡率的影响。方法 本研究使用的数据来自英国临床实践研究数据链确定的 2526 名 MS 患者和 9980 名年龄、性别和医生匹配的未患 MS 的对照组。结果 在 MS 诊断之前，MS 与 Charlson 合并症指数评分 1-2、3-4 或 >= 5 之间关联的调整比值比为 131 [95% CI，1.17-1.47]、1.65 (95% CI，1.20-2.26) 或 3.26 (95% CI，1.58-6.70)，分别。 MS 与心血管和神经/精神疾病的风险增加有关。诊断后，MS 与发生合并症风险增加之间关联的调整后风险比为 1.13（95% CI，1.00-1.29）。多发性硬化症患者出现肿瘤、肌肉骨骼/结缔组织疾病或神经/精神疾病等合并症的风险较高。与对照组相比，多发性硬化症患者的死亡风险较高，调整合并症后的风险比为 2.29（95% CI，1.81-2.73）。先前存在的合并症对死亡率存在剂量效应。结论 MS 患者在诊断前后出现多种合并症的风险增加，并且先前存在的合并症对生存有影响。
Background and purpose We aimed to determine the burden of comorbidities at the time of diagnosis of multiple sclerosis (MS), the risk of developing new comorbidities after diagnosis and the effect of comorbidities on mortality in patients with MS. Methods This study used data from 2526 patients with incident MS and 9980 age-, sex- and physician-matched controls without MS identified from the UK Clinical Practice Research Datalink. Results Before the MS diagnosis, the adjusted odds ratio for the association between MS and a Charlson comorbidity index score of 1-2, 3-4 or >= 5 was 131 [95% confidence interval (CI), 1.17-1.47], 1.65 (95% CI, 1.20-2.26) or 3.26 (95% CI, 1.58-6.70), respectively. MS was associated with increased risks of cardiovascular and neurological/mental diseases. After diagnosis, the adjusted hazard ratio for the association between MS and an increased risk of developing comorbidities was 1.13 (95% CI, 1.00-1.29). The risk of developing any comorbidity in terms of neoplasms, musculoskeletal/connective tissue diseases or neurological/mental diseases was higher in MS. Patients with MS had a higher mortality risk compared with controls, with a hazard ratio of 2.29 (95% CI, 1.81-2.73) after adjusting for comorbidities. There was a dose effect of pre-existing comorbidities on mortality. Conclusions Patients with MS have an increased risk of developing multiple comorbidities both before and after diagnosis and pre-existing comorbidities have an impact on survival.