title: Clinical predictors of disease progression in multiple sclerosis patients with relapsing onset in a nation-wide cohort.
abstract: BACKGROUND
  Predicting disease progression over time is challenging despite the available literature data.
  
  
  OBJECTIVE
  To assess whether baseline clinical variables of MS patients would predict the conversion to progressive phase of the disease.
  
  
  METHODS
  Utilizing the national MS registry, patients who had relapsing onsets and had confirmed EDSS score at baseline and follow-up visits were included. Primary progressive MS and CIS patients were excluded. Clinical variables (gender, age at onset, disease duration, number of relapses, EDSS score) were collected. The end point was conversion to secondary progressive MS. Chi Square and multivariable logistic regression were used to determine the influence of clinical variables on disease progression.
  
  
  RESULTS
  Data of 803 MS patients with relapsing onset were analyzed. Eighty five (10.6%) patients reached the end point. The risk of disease progression was significantly higher in men (p=0.015), in patients who developed MS≥40 years of age (p=0.041) and who had ≥3 relapses during their disease course (p<0.001). Spinal cord presentation at onset was predictive of progression (aOR=2.01; p=0.06) while optic neuritis at onset was associated with lower risk of progression (aOR=0.30; p=0.03). EDSS score at first visit did not influence disease progression when tested at 2 different cutoffs (EDSS<4 vs. ≥4 and EDSS<6 vs. ≥6) using multivariable logistic regression analysis (p=0.960 and p=0.866), respectively.
  
  
  CONCLUSIONS
  Men and patients who presented at age 40 yeas or beyond had increased risk of MS progression. Spinal cord symptoms at onset and 3 or more relapses were predictive of progression.
authors.affiliation: a Division of Neurology , Amiri Hospital, Sharq , Kuwait.|b Neurology Clinic, Dasman Diabetes Institute , Dasman , Kuwait.
authors.forename: R A
authors.initials: RA
authors.lastname: Alroughani
authors.affiliation: c Department of Community Medicine & Behavioural Sciences, Faculty of Medicine, Kuwait University , Jabriya , Kuwait.
authors.forename: S
authors.initials: S
authors.lastname: Akhtar
authors.affiliation: d Department of Neurology, Ibn Sina Hospital , Safat , Kuwait.|e Department of Neurology and Psychiatry, Minia University , Minia , Egypt.
authors.forename: S F
authors.initials: SF
authors.lastname: Ahmed
authors.affiliation: d Department of Neurology, Ibn Sina Hospital , Safat , Kuwait.|f Department of Medicine, Faculty of Medicine, Kuwait University , Safat , Kuwait.
authors.forename: J Y
authors.initials: JY
authors.lastname: Al-Hashel
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors
keywords: Multiple sclerosis; gender; predictor; progression; spinal cord