Assessment of comorbidity burden in persons with multiple sclerosis: observational study based on Belgrade population registry data

Abstract

Introduction: Comorbidity is one of major patients’ characteristics relevant to the clinical presentation and management of multiple sclerosis (MS). Aims: To estimate the prevalence of comorbidities in MS patients in Belgrade, Serbia, based on population-based registry data with special emphasis on cardiovascular disorders (CVD); and to determine their effects on MS course. Methods: Observational studies were perfomed at the Clinic of Neurology and Clinic of Endocrinology, diabetes and metabolic disorders, Clinical Center of Serbia, in the period 2016-2019. The Belgrade population MS registry was used as a source of data. Results: The most prevalent groups of comorbidities were psychiatric (20.59%) and CVD (15.23%) and most prevalent single comorbidities were depression (11.82%) and hypertension (11.41%). Progression index was significantly associated with the number of comorbidities (p<0.001). MS patients treated with disease-modifying therapies had a higher risk of comorbidity occurrence compared to those untreated (p=0.001). MS patients had a higher prevalence of insulin resistance (64.1%) compared to healthy individuals (30.8%), (p=0.008), and glucose level at 120’ during oral glucose tolerance test was independently associated with MS. Expanded Disability Status Scale (EDSS) score, physical activity, body mass index and type 2 diabetes comorbidity explained 48% of the variance in difference between chronological and vascular age in MS patients. EDSS score and MS phenotype were independent predictors of occurrence of CVD comorbidity, coronary artery disease and type 2 diabetes. Conclusion: Our findings implicate need for screening and early adequate management of different comorbidities in MS patients, having in mind its involvement in range of adverse outcomes in MS.

Uvod: Komorbiditeti predstavljaju jednu od ključnih karakteristika relevantnih za kliničku prezentaciju i ishod osoba sa multiplom sklerozom (MS). Cilj: Odrediti prevalenciju različitih grupa komorbiditeta kod osoba sa MS u populaciji Beograda, Srbija, sa posebnim osvrtom na kardiovaskularne bolesti (KVB) na osnovu podataka populacionog MS registra Beograda, kao i njihov uticaj na tok MS. Metod: Opservacione studije su sprovedene na Klinici za neurologiju i Klinici za endokrinologiju, dijabetes i bolesti metabolizma, Kliničkog centra Srbije, u periodu 2016-2019. godine. Kao izvor podataka korišćen je populacioni MS registar Beograda. Rezultati: Najprevalentnije grupe komorbiditeta su bile psihijatrijske bolesti (20,59%) i KVB (15,23%), a najprevalentniji pojedinačni komorbiditeti depresija (11,82%) i hipertenzija (11,41%). Indeks progresije onesposobljenosti je bio statistički značajno povezan sa brojem komorbiditeta (p<0.001). Osobe sa MS na terapiji lekovima koji modifikuju tok bolesti su imale veći rizik za pojavu komorbiditeta u odnosu na nelečene (p=0.001). Kod osoba sa MS je registrovana značajno viša prevalencija insulinske rezistencije (64,1%) u poređenju sa zdravim kontrolama (30,8%), (p=0,008), a nivo glukoze u 120’ oralnog testa tolerancije glukoze bio je nezavisno povezan sa MS. Skor proširene skale neurološke onesposobljenosti (EDSS), fizička aktivnost, indeks telesne mase i prisustvo tip 2 dijabetesa objasnili su 48% varijanse u razlici između hronološkog i vaskularnog uzrasta osoba sa MS. EDSS skor i MS fenotip predstavljaju nezavisne prediktore pojave KVB, koronarne arterijske bolesti i tip 2 dijabetesa kod osoba sa MS. Zaključak: Naši rezultati upućuju na potrebu za skriningom i ranim i adekvatnim menadžmentom komorbiditeta kod osoba sa MS, posebno imajući u vidu njihov uticaj na veliki broj neželjenih ishoda u MS.