Pizzamiglio, Chiara; Pitceathly, Robert DS; Lunn, Michael P; Brady, Stefen; De Marchi, Fabiola; Galan, Lucia; Heckmann, Jeannine M; ... Neuromuscular Diseases and COVID-19, Study Group; + view all Pizzamiglio, Chiara; Pitceathly, Robert DS; Lunn, Michael P; Brady, Stefen; De Marchi, Fabiola; Galan, Lucia; Heckmann, Jeannine M; Horga, Alejandro; Molnar, Maria J; Oliveira, Acary SB; Pinto, Wladimir BVR; Primiano, Guido; Santos, Ernestina; Schoser, Benedikt; Servidei, Serenella; Sgobbi Souza, Paulo V; Vishnu, Venugopalan; Hanna, Michael G; Dimachkie, Mazen M; Machado, Pedro M; Neuromuscular Diseases and COVID-19, Study Group; - view fewer (2022) Factors Associated with the Severity of COVID-19 Outcomes in People with Neuromuscular Diseases: Data from the International Neuromuscular COVID-19 Registry. European Journal of Neurology 10.1111/ene.15613. (In press).

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Abstract

Background and purpose: Clinical outcome information on patients with neuromuscular diseases (NMDs) who have been infected with SARS-CoV-2 is limited. The aim of this study was to determine factors associated with the severity of COVID-19 outcomes in people with NMDs. Methods: Cases of NMD, of any age, and confirmed/presumptive COVID-19, submitted to the International Neuromuscular COVID-19 Registry up to 31 December 2021, were included. A mutually exclusive ordinal COVID-19 severity scale was defined as follows: (1) no hospitalization; (2) hospitalization without oxygenation; (3) hospitalization with ventilation/oxygenation; and (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs) for severe outcome, adjusting for age, sex, race/ethnicity, NMD, comorbidities, baseline functional status (modified Rankin scale [mRS]), use of immunosuppressive/immunomodulatory medication, and pandemic calendar period. Results: Of 315 patients from 13 countries (mean age 50.3 [±17.7] years, 154 [48.9%] female), 175 (55.5%) were not hospitalized, 27 (8.6%) were hospitalized without supplemental oxygen, 91 (28.9%) were hospitalized with ventilation/supplemental oxygen, and 22 (7%) died. Higher odds of severe COVID-19 outcomes were observed for: age ≥50 years (50–64 years: OR 2.4, 95% confidence interval [CI] 1.33–4.31; >64 years: OR 4.16, 95% CI 2.12–8.15; both vs. <50 years); non-White race/ethnicity (OR 1.81, 95% CI 1.07–3.06; vs. White); mRS moderately severe/severe disability (OR 3.02, 95% CI 1.6–5.69; vs. no/slight/moderate disability); history of respiratory dysfunction (OR 3.16, 95% CI 1.79–5.58); obesity (OR 2.24, 95% CI 1.18–4.25); ≥3 comorbidities (OR 3.2, 95% CI 1.76–5.83; vs. ≤2; if comorbidity count used instead of specific comorbidities); glucocorticoid treatment (OR 2.33, 95% CI 1.14–4.78); and Guillain–Barré syndrome (OR 3.1, 95% CI 1.35–7.13; vs. mitochondrial disease). Conclusions: Among people with NMDs, there is a differential risk of COVID-19 outcomes according to demographic and clinical characteristics. These findings could be used to develop tailored management strategies and evidence-based recommendations for NMD patients.

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