AUTHOR=Huang Yangyu , Tan Ying , Shi Jiayu , Li Ke , Yan Jingwen , Guan Yuzhou 

TITLE=Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.767961

DOI=10.3389/fneur.2021.767961

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Life-threatening myasthenic crisis (MC) occurs in 10–20% of the patients with myasthenia gravis (MG). It is important to identify the predictors of progression to MC and prognosis in the patients with MG with acute exacerbations.</p><p><bold>Objective:</bold> This study aimed to explore the predictors of progression to MC in the patients with MG with acute onset of dyspnea and their short-term and long-term prognosis.</p><p><bold>Methods:</bold> This study is a retrospective cohort study. We collected and analyzed data on all the patients with MG with acute dyspnea over a 10-year period in a single center using the univariate and multivariate analysis.</p><p><bold>Results:</bold> Eighty-six patients with MG were included. In their first acute dyspnea episodes, 36 (41.9%) episodes eventually progressed to MC. A multivariate analysis showed that the early-onset MG (adjusted <italic>OR</italic>: 3.079, 95% <italic>CI</italic> 1.052–9.012) and respiratory infection as a trigger (adjusted <italic>OR</italic>: 3.926, 95% <italic>CI</italic> 1.141–13.510) were independent risk factors for the progression to MC, while intravenous immunoglobulin (IVIg) treatment prior to the mechanical ventilation (adjusted <italic>OR</italic>: 0.253, 95% <italic>CI</italic> 0.087–0.732) was a protective factor. The prognosis did not significantly differ between the patients with and without MC during the MG course, with a total of 45 (52.3%) patients reaching post-intervention status better than minimal manifestations at the last follow-up.</p><p><bold>Conclusion:</bold> When treating the patients with MG with acute dyspnea, the clinicians should be aware of the risk factors of progression to MC, such as early-onset MG and respiratory infection. IVIg is an effective treatment. With proper immunosuppressive therapy, this group of patients had an overall good long-term prognosis.</p>