Predictors of Mortality in Veterans with Multiple Sclerosis in an out-Patient Clinic Setting

Background: Examining factors that increase risk of death in veterans with MS may help reduce MS-related mortality.

Objectives: To determine the predictors of mortality in veterans with multiple sclerosis (MS) attending an out-patient clinic?

Methods: Retrospective review of electronic charts of 226 veterans with MS regularly followed in our MS clinic from 1/1/2000 to 12/31/2014.

Results: In this sample of 226 patients with MS, mortality rate at the end of 15 year study period was 14%. Comparisons between those who survived and those that died found significant differences for variables such as progressive MS type, initial motor presentation and presence of motor weakness and ataxia on examination, severity of the initial disease, presence of neurogenic bladder, pressure ulcers, diabetes mellitus and a lower body mass index in those who died. Main causes of death documented were: MS disease itself (57% of cases), infection (43%), and cancer and respiratory failure (18% each). Cox regression analysis showed MS type, severity of the initial disease, presence of pressure ulcers to be the main predictors of MS-related mortality. MS patients died prematurely with a standardized mortality rate 1.35 relative to the general (Oklahoman) population. 

Conclusions: Mortality rate in veterans with MS is 14%, and is influenced by motor complaints at presentation, MS type, and severity of the initial disease. MS disease itself and MS-related complications, such as presence of infection and respiratory failure were the contributing factors.