Importance: Multiple sclerosis patients have been considered a higher-risk population for COVID-19 due to the high prevalence of disability and disease-modifying therapy use; however, no study has identified clinical characteristics of multiple sclerosis associated with worse COVID-19 outcomes. Objective: To evaluate the clinical characteristics of multiple sclerosis, including staging, degree of disability, and disease-modifying therapy use that are associated with worse outcomes from COVID-19. Design: Prospective cohort study looking at the outcomes of multiple sclerosis patients with COVID-19 between March 1st and May 18th, 2020. Setting: This is a multicenter study of three distinct hospital systems within the U.S. Participants: The study included 40 consecutive patients with nasopharyngeal/oropharyngeal PCR-confirmed COVID-19 infection. Exposures: Multiple sclerosis staging, severe disability (based on baseline-extended disability status scale equal to or greater than 6.0) and disease-modifying therapy. Main Outcomes and Measure: Severity of COVID-19 infection was based on hospital course, where a mild course was defined as the patient not requiring hospital admission, moderate severity was defined as the patient requiring hospital admission to the general floor only, and most severe was defined as requiring intensive care unit admission and/or death. Results: For the 40 patients, the median age was 52(45.5-61) years, 16/40(40%) were male, and 21/40(52.5%) were African American. 19/40(47.5%) had mild courses, 15/40(37.5%) had moderate courses, and 6/40(15%) had severe courses. Patients with moderate and severe courses were significantly older than those with a mild course (57[50-63] years old and 66[58.8-69.5] years old vs 48[40-51.5] years old, P=0.0121, P=0.0373). There was differing prevalence of progressive multiple sclerosis staging in those with more severe courses (severe:2/6[33.3%]primary-progressing and 0/6[0%]secondary-progressing, moderate:1/14[7.14%] and 5/14[35.7%] vs mild:0/19[0%] and 1/19[5.26%], P=0.0075, 1 unknown). Significant disability was found in 1/19(5.26%) mild course-patients, but was in 9/15(60%, P=0.00435) of moderate course-patients and 2/6(33.3%, P=0.200) of severe course-patients. Disease-modifying therapy prevalence did not differ among courses (mild:17/19[89.5%], moderate:12/15[80%] and severe:3/6[50%], P=0.123). Conclusions and Relevance: Multiple sclerosis patients with more severe COVID-19 courses tended to be older, were more likely to suffer from progressive staging, and had a higher degree of disability. However, disease-modifying therapy use was not different among courses.

中文翻译：

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多发性硬化症患者中的COVID-19和严重感染的危险因素

重要性：多发性硬化症患者由于残疾和疾病改良疗法的普遍使用而被认为是COVID-19的高危人群；然而，尚无研究发现多发性硬化症的临床特征与COVID-19预后差有关。目的：评估多发性硬化症的临床特征，包括分期，致残程度和疾病改良疗法的使用，这些均与COVID-19的不良预后相关。设计：一项前瞻性队列研究，研究2020年3月1日至5月18日之间多发性硬化症COVID-19患者的结局。地点：这是一项针对美国参与者中三个不同医院系统的多中心研究：该研究包括40例连续的鼻咽/口咽PCR确认的COVID-19感染。暴露：多发性硬化分期，严重残疾（基于基线扩展的残疾状态量表等于或大于6.0）和疾病缓解疗法。主要结果和衡量指标：COVID-19感染的严重程度基于医院病程，其中轻度病程定义为不需要住院的患者，中度病情定义为仅需要进入普通病房的患者，并且最严重被定义为需要重症监护病房入院和/或死亡。结果：40例患者中位年龄为52（45.5-61）岁，男性为16/40（40％），非裔美国人为21/40（52.5％）。19/40（47.5％）为轻度课程，15/40（37.5％）为中度课程，6/40（15％）为重度课程。中度和重度病程的患者明显比轻度病程的患者大（57 [50-63]岁和66 [58.8-69.5]岁与48 [40-51.5]岁，P = 0.0121，P = 0.0373） ）。在病程较重的患者中，进展性多发性硬化分期的发生率有所不同（严重程度：初次进展为2/6 [33.3％]，继发进展为0/6 [0％]，中度为：1/14 [7.14％]， 5/14 [35.7％]与轻度：0/19 [0％]和1/19 [5.26％]，P = 0.0075，1个未知数）。1/19（5.26％）轻度课程患者发现严重残疾，但中度课程患者为9/15（60％，P = 0.00435）和重度患者为2/6（33.3％，P = 0.200）课程患者。不同疗程的疾病改善疗法患病率无差异（轻度：17/19 [89.5％]，中度：12/15 [80％]和重度：3/6 [50％]，P = 0.123）。结论和相关性：COVID-19病程较重的多发性硬化症患者往往年龄较大，更有可能进行进行性分期，并且残疾程度更高。但是，在各个疗程之间使用改变疾病的疗法并无不同。