tetano
Editor, Senior Moderator
J Neurol
. 2023 Feb 16;1-8.
doi: 10.1007/s00415-023-11618-0. Online ahead of print.
Modifiable risk factors of COVID-19 in patients with multiple sclerosis: a single-centre case-control study
Federico Montini[SUP] 1 [/SUP], Agostino Nozzolillo[SUP] 1 [/SUP], Paola M V Rancoita[SUP] 2 [/SUP], Chiara Zanetta[SUP] 1 [/SUP], Lucia Moiola[SUP] 1 [/SUP], Federica Cugnata[SUP] 2 [/SUP], Federica Esposito[SUP] 1 [/SUP], Maria A Rocca[SUP] 1 3 4 [/SUP], Vittorio Martinelli[SUP] #[/SUP][SUP] 1 [/SUP], Massimo Filippi[SUP] #[/SUP][SUP] 5 6 7 8 9 [/SUP]
Affiliations
Abstract
Background: Disease and treatment-associated immune system abnormalities may confer higher risk of Coronavirus disease 2019 (COVID-19) to people with multiple sclerosis (PwMS). We assessed modifiable risk factors associated with COVID-19 in PwMS.
Methods: Among patients referring to our MS Center, we retrospectively collected epidemiological, clinical and laboratory data of PwMS with confirmed COVID-19 between March 2020 and March 2021 (MS-COVID, n = 149). We pursued a 1:2 matching of a control group by collecting data of PwMS without history of previous COVID-19 (MS-NCOVID, n = 292). MS-COVID and MS-NCOVID were matched for age, expanded disability status scale (EDSS) and line of treatment. We compared neurological examination, premorbid vitamin D levels, anthropometric variables, life-style habits, working activity, and living environment between the two groups. Logistic regression and Bayesian network analyses were used to evaluate the association with COVID-19.
Results: MS-COVID and MS-NCOVID were similar in terms of age, sex, disease duration, EDSS, clinical phenotype and treatment. At multiple logistic regression, higher levels of vitamin D (OR 0.93, p < 0.0001) and active smoking status (OR 0.27, p < 0.0001) emerged as protective factors against COVID-19. In contrast, higher number of cohabitants (OR 1.26, p = 0.02) and works requiring direct external contact (OR 2.61, p = 0.0002) or in the healthcare sector (OR 3.73, p = 0.0019) resulted risk factors for COVID-19. Bayesian network analysis showed that patients working in the healthcare sector, and therefore exposed to increased risk of COVID-19, were usually non-smokers, possibly explaining the protective association between active smoking and COVID-19.
Conclusions: Higher Vitamin D levels and teleworking may prevent unnecessary risk of infection in PwMS.
Keywords: Case–control studies; Medical care; Multiple sclerosis; Viral infections.
. 2023 Feb 16;1-8.
doi: 10.1007/s00415-023-11618-0. Online ahead of print.
Modifiable risk factors of COVID-19 in patients with multiple sclerosis: a single-centre case-control study
Federico Montini[SUP] 1 [/SUP], Agostino Nozzolillo[SUP] 1 [/SUP], Paola M V Rancoita[SUP] 2 [/SUP], Chiara Zanetta[SUP] 1 [/SUP], Lucia Moiola[SUP] 1 [/SUP], Federica Cugnata[SUP] 2 [/SUP], Federica Esposito[SUP] 1 [/SUP], Maria A Rocca[SUP] 1 3 4 [/SUP], Vittorio Martinelli[SUP] #[/SUP][SUP] 1 [/SUP], Massimo Filippi[SUP] #[/SUP][SUP] 5 6 7 8 9 [/SUP]
Affiliations
- PMID: 36795147
- PMCID: PMC9933018
- DOI: 10.1007/s00415-023-11618-0
Abstract
Background: Disease and treatment-associated immune system abnormalities may confer higher risk of Coronavirus disease 2019 (COVID-19) to people with multiple sclerosis (PwMS). We assessed modifiable risk factors associated with COVID-19 in PwMS.
Methods: Among patients referring to our MS Center, we retrospectively collected epidemiological, clinical and laboratory data of PwMS with confirmed COVID-19 between March 2020 and March 2021 (MS-COVID, n = 149). We pursued a 1:2 matching of a control group by collecting data of PwMS without history of previous COVID-19 (MS-NCOVID, n = 292). MS-COVID and MS-NCOVID were matched for age, expanded disability status scale (EDSS) and line of treatment. We compared neurological examination, premorbid vitamin D levels, anthropometric variables, life-style habits, working activity, and living environment between the two groups. Logistic regression and Bayesian network analyses were used to evaluate the association with COVID-19.
Results: MS-COVID and MS-NCOVID were similar in terms of age, sex, disease duration, EDSS, clinical phenotype and treatment. At multiple logistic regression, higher levels of vitamin D (OR 0.93, p < 0.0001) and active smoking status (OR 0.27, p < 0.0001) emerged as protective factors against COVID-19. In contrast, higher number of cohabitants (OR 1.26, p = 0.02) and works requiring direct external contact (OR 2.61, p = 0.0002) or in the healthcare sector (OR 3.73, p = 0.0019) resulted risk factors for COVID-19. Bayesian network analysis showed that patients working in the healthcare sector, and therefore exposed to increased risk of COVID-19, were usually non-smokers, possibly explaining the protective association between active smoking and COVID-19.
Conclusions: Higher Vitamin D levels and teleworking may prevent unnecessary risk of infection in PwMS.
Keywords: Case–control studies; Medical care; Multiple sclerosis; Viral infections.