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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

See all articles by Alexandra Boubour

Alexandra Boubour

Cornell University - Department of Neurology

Carla Y. Kim

Cornell University - Department of Neurology

Sarah Torres

Cornell University - Department of Neurology

Dan Tong Jia

Northwestern University - Department of Neurology

Evan Hess

Columbia University - Vagelos College of Physicians and Surgeons (P&S)

Sibei Liu

Columbia University - Department of Biostatistics

Yifei Sun

Columbia University - Department of Biostatistics

Kathryn Fong

Swedish Neuroscience Institute

Samantha Epstein

Columbia University - Irving Medical Center; Columbia University - Columbia Multiple Sclerosis Center; Cornell University - Department of Neurology

Claire S. Riley

Columbia University - Center for Translational and Systems Neuroimmunology; Columbia University - Irving Medical Center; Columbia University - Columbia Multiple Sclerosis Center

Wendy Vargas

Columbia University - Irving Medical Center; Cornell University - Department of Neurology; Columbia University - Columbia Multiple Sclerosis Center

Rebecca Farber

Columbia University - Columbia Multiple Sclerosis Center

Helena Yan

Cornell University - Weill Cornell Medicine; Cornell University - Department of Pediatrics

Nicole Luche

Cornell University - Department of Pediatrics

Kerry Gao

Cornell University - Department of Pediatrics

Michael Tomani

Cornell University - Department of Pediatrics

Brittany Glassberg

Mount Sinai Health System - Department of Neurology

Michael Harmon

Mount Sinai Health System - Department of Neurology

Hai Hoang

Cornell University - Department of Pediatrics

Alison Navis

Mount Sinai Health System - Department of Neurology

Emily Schorr

Mount Sinai Health System - Department of Neurology

Avindra Nath

Government of the United States of America - National Institute of Neurological Disorders and Stroke (NINDS)

Stephen S. Morse

Columbia University - Department of Epidemiology

Jacqueline S. Gofshteyn

Cornell University - Department of Pediatrics

Anusha K. Yeshokumar

Mount Sinai Health System - Department of Neurology

Kiran T. Thakur

Department of Neurology - Columbia University Irving Medical Center

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

Suggested Citation

Boubour, Alexandra and Y. Kim, Carla and Torres, Sarah and Jia, Dan Tong and Hess, Evan and Liu, Sibei and Sun, Yifei and Fong, Kathryn and Epstein, Samantha and Epstein, Samantha and Riley, Claire S. and Riley, Claire S. and Vargas, Wendy and Farber, Rebecca and Yan, Helena and Luche, Nicole and Gao, Kerry and Tomani, Michael and Glassberg, Brittany and Harmon, Michael and Hoang, Hai and Navis, Alison and Schorr, Emily and Nath, Avindra and Morse, Stephen S. and Gofshteyn, Jacqueline S. and Yeshokumar, Anusha K. and Thakur, Kiran T., Sociodemographic and Clinical Factors Associated with Clinical Outcome in Neuroinflammatory Conditions: An Eight-Year Multicenter Retrospective Cohort Study. Available at SSRN: https://ssrn.com/abstract=4115468 or http://dx.doi.org/10.2139/ssrn.4115468

Alexandra Boubour

Cornell University - Department of Neurology ( email )

Carla Y. Kim

Cornell University - Department of Neurology ( email )

New York, NY
United States

Sarah Torres

Cornell University - Department of Neurology ( email )

Dan Tong Jia

Northwestern University - Department of Neurology ( email )

Chicago, IL
United States

Evan Hess

Columbia University - Vagelos College of Physicians and Surgeons (P&S) ( email )

Sibei Liu

Columbia University - Department of Biostatistics ( email )

722 West 168th Street
New York, NY 10032
United States

Yifei Sun

Columbia University - Department of Biostatistics

Kathryn Fong

Swedish Neuroscience Institute ( email )

550 17th Avenue Suite 500
Seattle, WA 98122
United States

Samantha Epstein

Columbia University - Irving Medical Center

Department of Medicine
William Black Building, 8th Floor BB8-801C
New York, NY NY 10032
United States

Columbia University - Columbia Multiple Sclerosis Center ( email )

New York
United States

Cornell University - Department of Neurology ( email )

Claire S. Riley

Columbia University - Center for Translational and Systems Neuroimmunology ( email )

630 West 168th Street, 3rd Floor, Suite 3-470
New York, NY 10032
United States

Columbia University - Irving Medical Center

Department of Medicine
William Black Building, 8th Floor BB8-801C
New York, NY NY 10032
United States

Columbia University - Columbia Multiple Sclerosis Center ( email )

Wendy Vargas

Columbia University - Irving Medical Center ( email )

William Black Building, 8th Floor BB8-801C
NY

Cornell University - Department of Neurology ( email )

New York, NY
United States

Columbia University - Columbia Multiple Sclerosis Center ( email )

Rebecca Farber

Columbia University - Columbia Multiple Sclerosis Center ( email )

Helena Yan

Cornell University - Weill Cornell Medicine ( email )

New York, NY
United States

Cornell University - Department of Pediatrics ( email )

United States

Nicole Luche

Cornell University - Department of Pediatrics ( email )

Kerry Gao

Cornell University - Department of Pediatrics ( email )

Michael Tomani

Cornell University - Department of Pediatrics ( email )

Brittany Glassberg

Mount Sinai Health System - Department of Neurology ( email )

New York, NY
United States

Michael Harmon

Mount Sinai Health System - Department of Neurology ( email )

Hai Hoang

Cornell University - Department of Pediatrics ( email )

Alison Navis

Mount Sinai Health System - Department of Neurology ( email )

Emily Schorr

Mount Sinai Health System - Department of Neurology ( email )

Avindra Nath

Government of the United States of America - National Institute of Neurological Disorders and Stroke (NINDS) ( email )

Stephen S. Morse

Columbia University - Department of Epidemiology ( email )

Jacqueline S. Gofshteyn

Cornell University - Department of Pediatrics ( email )

Anusha K. Yeshokumar

Mount Sinai Health System - Department of Neurology ( email )

Kiran T. Thakur (Contact Author)

Department of Neurology - Columbia University Irving Medical Center ( email )