title: Intensive care unit admission in multiple sclerosis: increased incidence and increased mortality.
abstract: OBJECTIVE
  To compare the incidence of, and mortality after, intensive care unit (ICU) admission as well as the characteristics of critical illness in the multiple sclerosis (MS) population vs the general population.
  
  
  METHODS
  We used population-based administrative data from the Canadian province of Manitoba for the period 1984 to 2010 and clinical data from 93% of admissions to provincial high-intensity adult ICUs. We identified 5,035 prevalent cases of MS and a cohort from the general population matched 5:1 on age, sex, and region of residence. We compared these populations using incidence rates and multivariable regression models adjusting for age, sex, comorbidity, and socioeconomic status.
  
  
  RESULTS
  From January 2000 to October 2009, the age- and sex-standardized annual incidence of ICU admission among prevalent cohorts was 0.51% to 1.07% in the MS population and 0.34% to 0.51% in matched controls. The adjusted risk of ICU admission was higher for the MS population (hazard ratio 1.45; 95% confidence interval [CI] 1.19-1.75) than for matched controls. The MS population was more likely to be admitted for infection than the matched controls (odds ratio 1.82; 95% CI 1.10-1.32). Compared with the matched controls admitted to ICUs, 1-year mortality was higher in the MS population (relative risk 2.06; 95% CI 1.32-3.07) and was particularly elevated in patients with MS who were younger than 40 years (relative risk 3.77; 95% CI 1.45-8.11). Causes of death were MS (9.3%), infections (37.0%), and other causes (52.9%).
  
  
  CONCLUSIONS
  Compared with the general population, the risk of ICU admission is higher in MS, and 1-year mortality after admission is higher. Greater attention to preventing infection and managing comorbidity is needed in the MS population.
authors.affiliation: From the Departments of Internal Medicine (R.A.M., C.N.B., C.A.P., C.A.H., A.G.) and Community Health Sciences (R.A.M., C.A.P., R.F., A.G.), and IBD Clinical and Research Centre (C.N.B.), University of Manitoba, Winnipeg; and Manitoba Centre for Health Policy (H.C., R.F., A.G.), Winnipeg, Canada. rmarrie@hsc.mb.ca.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.affiliation: From the Departments of Internal Medicine (R.A.M., C.N.B., C.A.P., C.A.H., A.G.) and Community Health Sciences (R.A.M., C.A.P., R.F., A.G.), and IBD Clinical and Research Centre (C.N.B.), University of Manitoba, Winnipeg; and Manitoba Centre for Health Policy (H.C., R.F., A.G.), Winnipeg, Canada.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
authors.affiliation: From the Departments of Internal Medicine (R.A.M., C.N.B., C.A.P., C.A.H., A.G.) and Community Health Sciences (R.A.M., C.A.P., R.F., A.G.), and IBD Clinical and Research Centre (C.N.B.), University of Manitoba, Winnipeg; and Manitoba Centre for Health Policy (H.C., R.F., A.G.), Winnipeg, Canada.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Peschken
authors.affiliation: From the Departments of Internal Medicine (R.A.M., C.N.B., C.A.P., C.A.H., A.G.) and Community Health Sciences (R.A.M., C.A.P., R.F., A.G.), and IBD Clinical and Research Centre (C.N.B.), University of Manitoba, Winnipeg; and Manitoba Centre for Health Policy (H.C., R.F., A.G.), Winnipeg, Canada.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Hitchon
authors.affiliation: From the Departments of Internal Medicine (R.A.M., C.N.B., C.A.P., C.A.H., A.G.) and Community Health Sciences (R.A.M., C.A.P., R.F., A.G.), and IBD Clinical and Research Centre (C.N.B.), University of Manitoba, Winnipeg; and Manitoba Centre for Health Policy (H.C., R.F., A.G.), Winnipeg, Canada.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: From the Departments of Internal Medicine (R.A.M., C.N.B., C.A.P., C.A.H., A.G.) and Community Health Sciences (R.A.M., C.A.P., R.F., A.G.), and IBD Clinical and Research Centre (C.N.B.), University of Manitoba, Winnipeg; and Manitoba Centre for Health Policy (H.C., R.F., A.G.), Winnipeg, Canada.
authors.forename: Randy
authors.initials: R
authors.lastname: Fransoo
authors.affiliation: From the Departments of Internal Medicine (R.A.M., C.N.B., C.A.P., C.A.H., A.G.) and Community Health Sciences (R.A.M., C.A.P., R.F., A.G.), and IBD Clinical and Research Centre (C.N.B.), University of Manitoba, Winnipeg; and Manitoba Centre for Health Policy (H.C., R.F., A.G.), Winnipeg, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Garland
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000401:mortality; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000401:mortality*; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D012306:Risk; D013997:Time Factors