Objective

To estimate whether the risk of death from COVID-19 in patients with multiple sclerosis (MS) exceeds that of the general population.

Methods

We conducted a pooled analysis of cohort studies on COVID-19 in patients with MS published until July 31, 2021. We calculated the pooled crude death rate (CDR) and estimated the indirectly-adjusted age-standardized lethality ratio (SLR) to assess the risk of death from COVID-19 in patients with MS as compared to general population.

Results

Out of 520 articles, 18 fulfilled criteria for pooled analysis, with a total of 5634 patients (28.6% males, mean age 41.8 years). Of them, 111 died, yielding a CDR of 1.97% (95% confidence intervals [CIs] 1.61–2.33). The estimated SLR was 1.24 (95% CIs 1.01–1.48) after indirect age-standardization using case-fatality rates obtained from the detailed surveillance data available at the World Health Organization (WHO) website. A leave-one-out sensitivity analysis and the analysis of temporal trends of SLR from March 2020 to July 2021 provided consistent findings.

Conclusions

Our pooled analysis suggests a 24%-increased risk of death from COVID-19 in patients with MS. These findings must be interpreted with caution, mainly because of the difficulties in COVID-19 case detection (especially in the first pandemic wave) and heterogeneity of the analyzed cohorts. Confirmation in larger population-based studies is warranted.

中文翻译：

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多发性硬化症患者死于 COVID-19 的风险增加：观察性研究的汇总分析

客观的

估计多发性硬化症 (MS) 患者死于 COVID-19 的风险是否超过一般人群。

方法

我们对截至 2021 年 7 月 31 日发表的 MS 患者 COVID-19 队列研究进行了汇总分析。我们计算了汇总粗死亡率 (CDR) 并估计了间接调整的年龄标准化致死率 (SLR) 以评估与一般人群相比，MS 患者死于 COVID-19 的风险。

结果

在 520 篇文章中，18 篇符合汇总分析标准，共有 5634 名患者（28.6% 为男性，平均年龄 41.8 岁）。其中，111 人死亡，CDR 为 1.97%（95% 置信区间 [CIs] 1.61–2.33）。使用从世界卫生组织 (WHO) 网站上提供的详细监测数据中获得的病死率进行间接年龄标准化后，估计的 SLR 为 1.24 (95% CIs 1.01–1.48)。留一法敏感性分析和对 2020 年 3 月至 2021 年 7 月 SLR 时间趋势的分析提供了一致的结果。

结论

我们的汇总分析表明，MS 患者死于 COVID-19 的风险增加了 24%。必须谨慎解释这些发现，主要是因为 COVID-19 病例检测困难（尤其是在第一波大流行中）和分析队列的异质性。需要在更大规模的基于人群的研究中进行确认。