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=Volume 12 - 2021

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=Background: Life-threatening myasthenic crisis (MC) occurs in 10-20% of myasthenia gravis (MG) patients. It is important to identify the predictors of progression to MC and prognosis in MG patients with acute exacerbations.
Objective: To explore the predictors of progression to MC in MG patients with acute onset of dyspnea and their short-term and long-term prognosis.
Methods: This study is a retrospective cohort study. We collected and analyzed data on all MG patients with acute dyspnea over a ten-year period in a single center using univariate and multivariate analysis.
Results: Eighty-six MG patients were included. In their first acute dyspnea episodes, 36 (41.9%) episodes eventually progressed to MC. Multivariate analysis showed that early-onset MG (adjusted OR:3.079, 95% CI 1.052-9.012) and respiratory infection as a trigger (adjusted OR: 3.926, 95% CI 1.141-13.510) were independent risk factors for progression to MC, while IVIg treatment prior to mechanical ventilation (adjusted OR: 0.253, 95% CI 0.087-0.732) was a protective factor. The prognosis did not significantly differ between patients with and without MC during the MG course, with a total of 45 (52.3%) patients reaching Postintervention Status better than Minimal Manifestations at the last follow-up.
Conclusion: When treating MG patients with acute dyspnea, clinicians should be aware of the risk factors of progression to MC including 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.