Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis

Background: Life-threatening myasthenic crisis (MC) occurs in 10–20% of the patients with myasthenia gravis (MG). It is important to identify the predictors of progression to MC and prognosis in the patients with MG with acute exacerbations.Objective: This study aimed to explore the predictors of pr...

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Autores principales:	Yangyu Huang, Ying Tan, Jiayu Shi, Ke Li, Jingwen Yan, Yuzhou Guan
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	myasthenia gravis myasthenic crisis impending myasthenic crisis early-onset intravenous immunoglobulin mechanical ventilation Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/eb48898906ad4647bd5a84c3a5dde986
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spelling	oai:doaj.org-article:eb48898906ad4647bd5a84c3a5dde9862021-11-18T08:18:21ZPatients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis1664-229510.3389/fneur.2021.767961https://doaj.org/article/eb48898906ad4647bd5a84c3a5dde9862021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.767961/fullhttps://doaj.org/toc/1664-2295Background: Life-threatening myasthenic crisis (MC) occurs in 10–20% of the patients with myasthenia gravis (MG). It is important to identify the predictors of progression to MC and prognosis in the patients with MG with acute exacerbations.Objective: This study aimed to explore the predictors of progression to MC in the patients with MG with acute onset of dyspnea and their short-term and long-term prognosis.Methods: This study is a retrospective cohort study. We collected and analyzed data on all the patients with MG with acute dyspnea over a 10-year period in a single center using the univariate and multivariate analysis.Results: Eighty-six patients with MG were included. In their first acute dyspnea episodes, 36 (41.9%) episodes eventually progressed to MC. A multivariate analysis showed that the early-onset MG (adjusted OR: 3.079, 95% CI 1.052–9.012) and respiratory infection as a trigger (adjusted OR: 3.926, 95% CI 1.141–13.510) were independent risk factors for the progression to MC, while intravenous immunoglobulin (IVIg) treatment prior to the mechanical ventilation (adjusted OR: 0.253, 95% CI 0.087–0.732) was a protective factor. The prognosis did not significantly differ between the patients with and without MC during the MG course, with a total of 45 (52.3%) patients reaching post-intervention status better than minimal manifestations at the last follow-up.Conclusion: When treating the patients with MG with acute dyspnea, the clinicians should be aware of the risk factors of progression to MC, such as early-onset MG and respiratory infection. IVIg is an effective treatment. With proper immunosuppressive therapy, this group of patients had an overall good long-term prognosis.Yangyu HuangYing TanJiayu ShiKe LiJingwen YanYuzhou GuanFrontiers Media S.A.articlemyasthenia gravismyasthenic crisisimpending myasthenic crisisearly-onsetintravenous immunoglobulinmechanical ventilationNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	myasthenia gravis myasthenic crisis impending myasthenic crisis early-onset intravenous immunoglobulin mechanical ventilation Neurology. Diseases of the nervous system RC346-429
spellingShingle	myasthenia gravis myasthenic crisis impending myasthenic crisis early-onset intravenous immunoglobulin mechanical ventilation Neurology. Diseases of the nervous system RC346-429 Yangyu Huang Ying Tan Jiayu Shi Ke Li Jingwen Yan Yuzhou Guan Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis
description	Background: Life-threatening myasthenic crisis (MC) occurs in 10–20% of the patients with myasthenia gravis (MG). It is important to identify the predictors of progression to MC and prognosis in the patients with MG with acute exacerbations.Objective: This study aimed to explore the predictors of progression to MC in the patients with MG with acute onset of dyspnea and their short-term and long-term prognosis.Methods: This study is a retrospective cohort study. We collected and analyzed data on all the patients with MG with acute dyspnea over a 10-year period in a single center using the univariate and multivariate analysis.Results: Eighty-six patients with MG were included. In their first acute dyspnea episodes, 36 (41.9%) episodes eventually progressed to MC. A multivariate analysis showed that the early-onset MG (adjusted OR: 3.079, 95% CI 1.052–9.012) and respiratory infection as a trigger (adjusted OR: 3.926, 95% CI 1.141–13.510) were independent risk factors for the progression to MC, while intravenous immunoglobulin (IVIg) treatment prior to the mechanical ventilation (adjusted OR: 0.253, 95% CI 0.087–0.732) was a protective factor. The prognosis did not significantly differ between the patients with and without MC during the MG course, with a total of 45 (52.3%) patients reaching post-intervention status better than minimal manifestations at the last follow-up.Conclusion: When treating the patients with MG with acute dyspnea, the clinicians should be aware of the risk factors of progression to MC, such as early-onset MG and respiratory infection. IVIg is an effective treatment. With proper immunosuppressive therapy, this group of patients had an overall good long-term prognosis.
format	article
author	Yangyu Huang Ying Tan Jiayu Shi Ke Li Jingwen Yan Yuzhou Guan
author_facet	Yangyu Huang Ying Tan Jiayu Shi Ke Li Jingwen Yan Yuzhou Guan
author_sort	Yangyu Huang
title	Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis
title_short	Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis
title_full	Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis
title_fullStr	Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis
title_full_unstemmed	Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis
title_sort	patients with myasthenia gravis with acute onset of dyspnea: predictors of progression to myasthenic crisis and prognosis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/eb48898906ad4647bd5a84c3a5dde986
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Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis

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