Increased Severe COVID-19-Related Fatality in Hospitalized Multiple Sclerosis Patients

Abstract

The aim of this study was to assess the case fatality ratio (CFR) in persons with multiple sclerosis (PwMS) hospitalized due to severe COVID-19, and to investigate the role of risk factors for fatal outcome in this well-defined cohort. This case series study included all PwMS (N=32) with severe COVID-19, who were hospitalized in the COVID-19 referral center in Belgrade from January 2021 to January 2022. Eight out of these 32 patients died from COVID-19 (CFR 25%). The cause of death was sepsis in 7 patients and pulmonary embolism in one patient. Results of univariate logistic regression analyses demonstrated that older age, EDSS higher than 6.0, progressive multiple sclerosis (MS) forms, cardiovascular comorbidities, and longer duration of hospital stay statistically significantly increased the risk of COVID-19-related death in MS patients. Treatment with ocrelizumab was associated with more than 2-fold increased death risk (p=0.408). Multivariate logistic regression analysis showed that progressive forms of MS (p=0.044) and longer hospitalization (p=0.006) significantly increased the risk of death in our MS cohort. In our study, older age, presence of comorbidities, and progressive disease course were independent predictors of increased lethality of COVID-19 in PwMS. More intense monitoring may be warranted in PwMS treated with anti-CD20 agents.

Keywords

• Multiple sclerosis
• Severe COVID-19
• Fatality
• Risk factors