The 3 Most Common Etiologies for Hospital Readmission in MS, NMOSD

In patients with multiple sclerosis (MS) as well as those with neuromyelitis optica spectrum disorder (NMOSD), the most common etiologies associated with 30-day hospital readmission rates were neurologic, infectious, and respiratory, according to study results presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2023, held in San Diego, California, from February 23 to 25.

MS and NMOSD are both inflammatory, central nervous system, demyelinating disorders that are associated with neurologic decline. Patients with both conditions exhibit primarily a relapsing or remitting disease course, which results in multiple hospitalizations and occasionally rehospitalizations. “Hospitalization readmission rates are important metrics that have direct financial implications to hospitals and serve as an indicator of disease burden on patients and society,” according to researchers of the study.

For the study, researchers sought to identify high-risk patients with MS and NMOSD for rehospitalization and related comorbidities/characteristics that can be utilized as predictors of readmission. They hypothesized that by contrasting the high-risk features of both disorders, this might provide insight into the differences between the 2 conditions. The 2017 National Readmission Database was used to search for hospital admissions in the United States for MS and NMOSD.Individuals with a hospital readmission within 30 days of discharge from the index hospitalization were evaluated.

The researchers found that the 30-day readmission rate was 10.6% (range, 10.4%-10.8%) for MS and 11.9% (range, 10.6%-13.3%) for NMOSD. Female gender played a protective role in readmission rates in patients with MS but not those with NMOSD; in contrast, younger age was protective in patients with NMOSD but not those with MS.

In both disorders, respiratory failure and peripheral vascular disease were predictive of hospital readmissions.

In patients with MS, the following conditions were predictive of readmission:

• heart failure,
• hypertension,
• diabetes,
• anemia,
• coagulation disorders,
• chronic obstructive pulmonary disorder,
• acute kidney injury,
• chronic kidney disease,
• liver failure,
• infections,
• cancer,
• depression, and
• substance abuse.

Meanwhile, among patients with NMOSD, neurocognitive disorders and neurologic blindness were predictive of readmission.

The use of intravenous immunoglobulin or plasma exchange did not impact rehospitalization among patients with MS. However, the use of plasma exchange among patients with NMOSD increased the likelihood of readmission. Additionally, obstructive sleep apnea was protective of readmission in those with MS, whereas hyperlipidemia was shown to be protective in those with NMOSD. With the most common etiologies associated with 30-day readmission determined to be neurologic, respiratory, and infectious for both MS and NMOSD, the researchers concluded, “Targeted treatment towards these etiologies may result in decreased overall readmission thereby decreasing overall disease burden.”