Outcomes, Disparities, and Predictors of Meningitis in Multiple Sclerosis Patient Hospitalization
Muhammad Tayyab Muzaffar Chaychi1, Hafiz Maaz2, Rawdah Shakil3, Muhammad Sohaib4, Muhammad Ahmed5
1University of South Florida, 2Quaid-e-Azam Medical College, Bahawalpur Pakistan, 3Dow University of Health Sciences, 4Rollins Shool of Public Health, Emory University, 5Medical College of Georgia, Augusta University
Objective:
To evaluate prevalence, outcomes (mortality, resource utilization), and predictors of concurrent meningitis in a nationally representative MS hospitalization sample.
Background:
CNS infection outcomes are worse in Multiple sclerosis patients. There is limited data at national level to study outcomes of meningitis in patient with diagnosis of multiple sclerosis. The goal of this study is to identify characteristics and outcomes of meningitis in multiple sclerosis patient
Design/Methods:
A retrospective cohort study using a NIS identified adult MS hospitalizations with/without concurrent meningitis Survey-weighted multivariable models assessed independent predictors of meningitis and associations with mortality, length of stay, and total charges after adjusting for patient and hospital characteristics.
Results:
Among 1,054,115 survey-weighted MS hospitalizations (2016-2022), meningitis occurred in 0.16% (n=1,730). Meningitis patients were younger (51.8 vs 57.2 years, p<0.001) with lower comorbidity burden (0.87 vs 1.06, p<0.001). After adjustment, meningitis was associated with significantly longer LOS (10.36 vs 5.56 days; difference +4.80 days, 95% CI 3.29-6.31, p<0.001) and 98% higher charges ($117,133 vs $59,182; ratio 1.98, 95% CI 1.71-2.29, p<0.001). Overall adjusted mortality did not differ significantly (aOR 1.67, 95% CI 0.82-3.41, p=0.157), with predicted mortality 3.08% vs 1.88%. However, bacterial meningitis showed four-fold higher mortality (aOR 4.15, 95% CI 1.47-11.69, p=0.007; adjusted probability 7.16% vs 1.88%). No deaths occurred among viral meningitis cases. Independent predictors of meningitis included younger age (aOR 0.981 per year, p<0.001), ED involvement (aOR 1.47, 95% CI 1.10-1.97), and private insurance versus Medicare (aOR 1.77, 95% CI 1.33-2.36). Highest-income ZIP quartile showed lower odds (Q4 vs Q1: aOR 0.69, 95% CI 0.49-0.96). Viral meningitis was associated with younger age (RRR 0.97 per year, 95% CI 0.96-0.99), private insurance (RRR2.06, 95% CI 1.20-3.53), and trauma center ED admission (RRR2.93, 95% CI 1.45-5.91).
Conclusions:
Meningitis in MS patients, though rare, significantly increases healthcare utilization with doubled charges and five additional hospitalization days.
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