Are Neurological Manifestations a Predictor of Poor Prognosis in Patients with Neuro-Autoimmune Disease?
Nabeel Ahmed1, Umair Azhar2, Mohsen Ahmed3, Afaaq Ahmed4, Sania Azhar5, Nizar Souayah3
1Stony Brook University, 2Einstein College of Medicine, 3Rutgers New Jersey Medical school, 4Kentucky College of Osteopathic Medicine, 5New York Medical College
Objective:
Investigate the effect of neurological manifestations (NM) on the prognosis of patients with neuroautoimmune disease (NAD).
Background:
NM in patients with underlying illness has been shown to increase overall mortality and predict a poor prognosis. However, the effect of NM on the prognosis of patients with NAD has not yet been fully characterized.
Design/Methods:
A retrospective analysis on 34464 patients hospitalized at a tertiary care center in a major metropolitan area was conducted. The outcomes compared included the prevalence of NM among patients with and without neuro-autoimmune disease (NAD and nNAD). The outcomes of the initial disposition after discharge, length of hospital stay, ICU admission, prevalence of high risk comorbidities, and death among patients with NM and with and without neuro-autoimmune disease (NMNAD and NMnNAD) was also determined.
Results:
There was no significant difference in the prevalence of NM between patients with NAD or nNAD (14.2%, 12.5%, p>0.05). Mortality was 7.4% in NMNAD and 12.8% in NMnNAD (p>0.05). ICU admissions were 22.2% in NMNAD and 36.2% in NMnNAD (p>0.05). Average length of stay was 12 and 10 days for NMNAD and NMnNAD respectively (p>0.05). Prevalence of high risk comorbidities was 74.1% in NMNAD and 76.2% in NMnNAD (p>0.05). Discharge to hospice and skilled nursing facilities was significantly higher in NMNAD compared to NMnNAD (64% vs 42.2% p<0.05).
Conclusions:
There is a significant increase in discharge to hospice and skilled nursing facilities in NMNAD compared to NMnNAD patients. However, there is no difference in mortality, ICU admissions, average length of stay and prevalence of comorbid conditions between each group. Work is in progress to increase sample size and investigate separately the prognosis of autoimmunity affecting the central nervous system vs peripheral nervous system, autoimmunity affecting exclusively the nervous system vs autoimmunity affecting other organ systems and autoimmunity without neurological manifestations.