Urinary tract infection is top reason for hospital admissions in MS
Evidence suggests being hospitalized contributes to disability progression
People with multiple sclerosis (MS) are primarily admitted to the hospital due to urinary tract infections, which indicates that bladder problems need to be better managed in this population, a study shows.
Neurological problems without an identifiable cause came second among the reasons for admission to a hospital, likely because nearly half of MS patients had a progressive form of the disease that cannot be properly managed with disease-modifying therapies (DMTs).
Still, patients remained in the hospital for a similar length of time as people from the general population and were readmitted within 30 days just as frequently.
The study, “Reasons for Hospital Admission in Individuals With Multiple Sclerosis,” was published in the International Journal of MS Care by three researchers at Duke University Hospital in Durham, North Carolina.
“Because many individuals with multiple sclerosis are admitted to the hospital without an identifiable cause, increasing access to outpatient care and subsequent workups may help reduce preventable admissions,” the researchers wrote.
In MS, the body’s immune system launches an inflammatory attack that damages the myelin sheath, a protective covering around nerve cells in the brain and spinal cord. The resulting damage gives rise to a range of symptoms, the most common being movement problems and fatigue.
While MS symptoms are enough to sometimes require hospitalization, people with MS also are more likely to have other chronic conditions that further increase their admission rates.
Urinary tract infections and MS
Evidence suggests being hospitalized contributes to disability progression in MS, but “there are limited data on the reasons for their hospital admissions,” wrote the researchers, who examined data from 210 adults admitted to Duke University Hospital from 2018 through 2019 to uncover trends that lead to admissions and identify areas for possible intervention. The patients’ mean age was 54.4 and there were about three times as many women as men.
Most patients (52.4%) had relapsing-remitting MS, while 28.3% had secondary progressive MS, and 14.2% had primary progressive MS. The MS type wasn’t recorded for nine patients (4.2%).
Nearly two-thirds (62.4%) used devices, such as canes, walkers, or wheelchairs, to assist with movement, indicating a high disability level in this patient group.
The most common reason for hospitalization was urinary tract infection (10.3%). Because people with MS often have bladder problems, including frequent urination or difficulty urinating, “it is not surprising that a [urinary tract infection] was the most common reason for admission,” the researchers wrote.
Neurological problems without an identifiable cause were the second most common reason for a hospital admission (9.2%), followed by an MS relapse (7.6%), and falls, difficulty walking, and stiffness combined (6.2%).
Nearly half the patients (48.2%) admitted to the hospital weren’t taking a DMT. These patients had a similar age as those who were receiving treatment, but the reasons for being admitted differed.
The most common reasons for admission in untreated patients were relapses (15.7%), urinary tract infection (11%), and lung infection (7.9%), compared with urinary tract infection (13%), neurological problems with no clear cause (13%), and skin infection (5.8%) in treated patients.
On average, patients stayed in the hospital 6.1 days, a length of stay comparable to that of the general population (5.5 days). Some patients returned within 30 days of discharge (14.9%), a rate also similar to the general population’s (15.5%). For those patients, the most common reasons for readmission were pain (25%) and infection (22.5%).
“We now have more treatment options for MS,” but “our study results suggest that the individuals with MS with the highest health care utilization are those who are untreated,” the researchers wrote. “Untreated MS may lead to more hospitalizations because of symptom complications of and/or accumulated disability.”
Actively managing bladder problems to reduce the risk of urinary tract infection is needed, along with “future research … to identify the factors that can be addressed to support these patients and reduce preventable hospitalizations,” the researchers wrote.
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