Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Pichler, A.
Assessment of mortality rates and comorbidities in patients with multiple sclerosis in Austria and their impact on disability and morphologic brain abnormalities
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2016. pp.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Berghold Andrea
- Enzinger Christian
- Fazekas Franz
- Altmetrics:
- Abstract:
- Background: Multiple sclerosis (MS) is associated with a 3-times higher risk of death compared to the general population and life expectancy is about 10 years shorter. The reasons of death appear to be directly related to MS in about 50% of the cases. For Austria, data on the mortality of MS patients and their cause are sparse. Similarly, limited information of the spectrum of comorbidities and the influence of comorbidities on the course of MS including morphologic brain abnormalities exists. Aim: First, actual mortality data and rates for Austria shall be assessed. Second, the type and prevalence of comorbidities in MS and their impact on the course of MS shall be examined. Third, the evolution of brain volume changes over time in relation to the development of the disease and in association with comorbidities shall be evaluated. Methods: The database of Statistics Austria was used to assess the evolution of the actual mortality rates for Austria on a national and regional basis. Comorbidities were obtained from a dataset of an initial cohort of 324 patients who were treated ambulatory or stationary at the University hospital of Graz between 2006 and 2012. As MS specific clinical data were not available in all of these patients, we focused on a sub-group of 120 individuals who were regularly seen in our outpatient clinic and have consecutive MRI scans. Magnetic resonance imaging (MRI) parameters included T2-lesion load (T2-LL), normalized brain volume (NBV), cortical grey (cGMV) and white matter volume (WMV) and volumes of the thalami (TV) and basal ganglia (BGV). The temporal evolution of brain volume changes and lesion load was investigated separately with and without inclusion of comorbidities. Additionally, potential sex specific differences and differences regarding the disease course (clinically isolated syndrome, CIS versus clinically definite MS, CDMS) were looked into. Results: Mortality rates: Between 1970 and 2000, mortality rates in MS (i.e. death due to MS per 100 000 people) decreased in both men and women (1970-79: women 1.43, men 0.91 versus 2000-09: women 0.75, men 0.75). During the last decade, however, a slight increase of mortality rates in women (women 0.79 versus. men 0.62) could be observed. Regional mortality rates showed a slight west to east gradient with lower mortality rates in western regions (Tyrol 0.68 versus Vienna 0.96). In 2014, the mean age at death due to MS was 67.3 years for women and 62.9 years for men. Assessment of comorbidities: 120 patients with either a CIS; n=63 or with CDMS; n=57 at baseline could be identified. 54 patients had at least one comorbidity. Depression (20%) was the most common comorbidity, followed by arterial hypertension (11.7%) and autoimmune thyreoditis (9.2%). The presence of one or more comorbidities was neither associated with the disease course nor with disability. Analysis of brain volume changes and lesion load: The mean follow-up period between first and second scan was 43 months. At baseline all brain volume metrics, except cGMV, were significantly lower and the T2-LL was significantly higher in MS compared to CIS. During follow-up, only the PBVC was higher in MS (p=0.008) and this difference was driven by converters from CIS to MS. When comorbidities are included in this analysis, patients with at least one comorbidity had a significantly lower total brain volume (p=0.001) as well as grey (p=0.06) and white matter volume (0.03) at the baseline MRI scan, whereas the T2-LL was higher (p=0.012). Conclusion: Mortality rates in Austria were increasing during the last decade, potentially due to a higher awareness of MS in the population. It could be shown that comorbidities are present even in the early stages of MS and are associated with lower brain volumes.