(1164) COVID19 Increases Risk of Acute Respiratory Failure and Mortality in Neuromuscular Disorder Patients

Introduction: Neuromuscular disorders (NMD) like Lambert-Eaton (LE) and Myasthenia Gravis (MG) are associated with an increased risk of respiratory failure. Respiratory muscle weakness can lead to inadequate ventilation, progressive hypercapnic respiratory failure, and recurrent pneumonia, accounting for a major cause of morbidity in NMD patients. Recent CHEST guidelines highlight the complexity of respiratory management among these patients. COVID-19 has been associated with a wide range of complications. Although there is no evidence that patients with NMD confer a higher infection risk of COVID-19, patients with LE or MG may be at an increased risk of manifesting severe symptoms and complications of COVID-19 due to underlying immunocompromised state related to baseline therapies and respiratory muscle weakness. Studies examining the outcomes of LE and MG patients affected with COVID-19 compared to the general population are limited.

Methods: Patients with COVID-19 were sampled using the National Inpatient Sample database for years 2019-2020. Baseline demographics and comorbidities were collected. Patients younger than 18 years old and with missing values were excluded. Patients were stratified into NMD and non-NMD groups and t-tests, chi-square analyses, and binary logistic regression analyses were performed to evaluate the impact of COVID-19 infection on outcomes and comorbidities.

Results: Among 321536 patients infected with Covid-19, 678 (0.2%) had NMD. NMD patients had increased rates of intubation (22.0% vs 12.5%; p<.001), ARDS (9.7% vs 6.0%; p< .001) and severe sepsis (17.1% vs. 11.9%; p< .001) relative to non-NMD patients. NMD patients had increased odds of intubation [OR: 2.0, CI 1.6-2.4, p<.001), ARDS (OR: 1.7, CI 1.3-2.2; p<.001), acute respiratory failure (OR: 1.0, CI 1.2-1.4; p< 0.44), severe sepsis (OR: 1.5, CI 1.2-1.8; p<.001), severe Covid infection (OR: 1.3, CI: 1.1-1.6; p<.001), cardiac arrest (OR: 1.6, CI 1.1-2.3; p<.018), and in-hospital mortality (OR: 1.5, CI 1.2-1.8; p<.001).

Conclusions: There was an increased risk of respiratory failure, intubation, and mortality in COVID-19 patients with LE and MG compared to the general population. These findings highlight the importance of defining a standardized, multidisciplinary care method for NMD patients during COVID outbreaks.