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Sociodemographic and Clinical Factors Associated with Clinical Outcome in Neuroinflammatory Conditions: An Eight-Year Multicenter Retrospective Cohort Study
26 Pages Posted: 20 May 2022
More...Abstract
Background: Little is known about the impact of sociodemographic and clinical factors on health outcomes in neuroinflammatory conditions. We sought to investigate relationships between sociodemographic and clinical factors, etiology, and clinical outcomes among patients with all-cause neuroinflammatory conditions.
Methods: This retrospective cohort study was conducted between January 1, 2010 and December 31, 2017 at three large tertiary care centers in New York City. Hospital-admitted patients aged ≥16 years meeting case definitions for neuroinflammatory conditions were included, with data obtained from electronic medical records. Poor clinical outcome was defined as length of hospital stay (LOS) ≥2 weeks and/or discharge to a location other than home. Descriptive statistics and multivariate logistic regressions were performed.
Findings: Of 830 patients, mean age was 49·0[[EQUATION]]19·5 years, and 439 (52·9%) were female. Three hundred three (36·5%) patients had a definitive etiology (immune-mediated: N=98, 11·8%; infectious: N=205, 24·7%), and 527 (63·5%) had an unknown etiology. Median LOS was 10·0 (IQR, 5·0-21·0) days, and 517 (62·4%) patients were discharged home. Poor clinical outcome was more likely in older patients (prolonged LOS: OR, 1·03; 95% CI, 1·01-1·05 and discharge home: OR, 0·96; 95% CI, 0·94-0·98), patients with a history of immunodeficiency (prolonged LOS: OR, 2·11; 95% CI, 1·45-3·07 and discharge home: OR, 0·69; 95% CI, 0·47-0·98), patients experiencing status epilepticus (prolonged LOS: OR, 3·10; 95% CI, 1·66-5·78 and discharge home: OR, 0·49; 95% CI, 0·27-0·90), and patients with an infectious (versus immune-mediated) etiology (prolonged LOS: OR, 3·71; 95% CI, 2·03-6·77 and discharge home: OR, 0·29; 95% CI, 0·16-0·52). No other covariates were significantly associated with clinical outcomes.
Interpretation: Older age, history of immunodeficiency, status epilepticus during hospitalization, and infectious etiology were independently and significantly associated with poor clinical outcome. Our findings may contribute to systematic interventions and prevention efforts to enhance health equity and mitigate population-level burden of neuroinflammatory conditions.
Keywords: neuroinfectious disease, neuroinflammatory, social determinants of health, health inequity, outcome
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