Hospital admission due to infections in multiple sclerosis patients
Version of Record online: 16 MAR 2013
© 2013 The Author(s) European Journal of Neurology © 2013 EFNS
European Journal of Neurology
Volume 20, Issue 8, pages 1153–1160, August 2013
How to Cite
Montgomery, S., Hillert, J. and Bahmanyar, S. (2013), Hospital admission due to infections in multiple sclerosis patients. European Journal of Neurology, 20: 1153–1160. doi: 10.1111/ene.12130
- Issue online: 5 JUL 2013
- Version of Record online: 16 MAR 2013
- Manuscript Accepted: 4 FEB 2013
- Manuscript Received: 11 NOV 2012
- hospital admission;
- multiple sclerosis
Background and purpose
Multiple sclerosis (MS) patients are at increased infection risk. Here the influences of susceptibility, severity and surveillance bias on infection-related hospital admission are assessed.
Swedish registers identified 20 276 patients with MS, matched with 203 951 people from the general population without MS. Risk of first hospital admission for infection and mortality over 36 years was estimated by Poisson regression.
Multiple sclerosis was associated with an increased hospital admission risk for all infections, with an adjusted relative risk (and 95% confidence interval) of 4.26 (4.13–4.40). A proportion of this raised risk was probably due to surveillance and referral bias, although a raised risk remained when MS was compared with other immune-mediated diseases. The 1-month mortality rate following hospital admission for infection was higher in MS patients than in the comparison cohort, with a relative risk of 4.69 (4.21–5.22). There was no clear temporal trend in the results, and risks were higher in males and varied by MS phenotype.
Higher hospital admission rates among MS patients for infection are likely to be due to a combination of surveillance bias, cautious medical management and greater susceptibility to severe infections. MS-related functional limitations may increase infection risk and this should be considered in MS management.