Abstract Details

Title Mortality associated with Myelopathy and Transverse Myelitis in the National US Veterans Affairs Health Administration

Topic Autoimmune Neurology

Presentation(s) Autoimmune Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 043

Objective To characterize the clinical findings associated with mortality in myelopathy and transverse myelitis (TM) patients evaluated at the National Veterans Affairs Health Administration (VA).

Background Myelopathy and transverse myelitis (TM) are the result of injury to the spinal cord. Little is known about the mortality within this population.

Design/Methods We performed a retrospective review utilizing the VA EMR to identify all cases of TM from October 1999 to September 2015 using ICD-9 codes. We confirmed the diagnosis with an individual chart review based on TM Consortium Diagnostic Criteria from 2002. We analyzed demographics, disease characteristics, and mortality data and performed a multivariate logistic regression to explore associations with mortality.

Results We identified 4084 patients with an ICD code for TM, and confirmed the diagnosis in 1006 individuals (90.7% males, median age at symptom onset 49.8 years [IQR 34.6 – 60.4], 67.8% Caucasian and 31.5% smokers). Average length of follow-up was 12.1 years (IGR 7.7 – 16.7). The median modified Rankin score (mRS) at symptom onset was 3 (IQR 2,4). A total of 95 patients (9.4%) passed away during our 16-year search period (93.7% males, median age at death 66.3 years [IQR 2.3 – 75.8] and 71.6% Caucasian). The most common cause of death was related to malignancy (20%), comorbidities (16.8%) or TM complications (9.5%). The median survival time was 6.1 years (range 2.6 – 13.1) from symptom onset. In our logistic model, increases in mortality were associated with mRS at follow-up (OR 3.54, 95% CI 2.33 – 5.11) and tobacco use (OR 4.72, 95% CI 1.98 – 11.27). There was no association with sex (p = 0.77) or race (p = 0.85).

Conclusions Within the national VA system, we identified a mortality proportion of 9.4% in our TM and myelopathy cohort. Smoking status and disability at follow-up were significantly associated with mortality.

Authors/Disclosures
Justin Abbatemarco, MD PRESENTER	Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech . Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics, Inc.. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. The institution of Dr. Abbatemarco has received research support from Amgen.
Jonathan R. Galli, MD (University of Utah)	Dr. Galli has nothing to disclose.
Michael Sweeney, MD (University of Louisville)	Dr. Sweeney has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Sweeney has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis.
M. M. Paz Soldan, MD, PhD (Mayo Clinic)	Dr. Paz Soldan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Paz Soldan has received research support from National Institutes of Health. The institution of Dr. Paz Soldan has received research support from National Multiple Sclerosis Society. The institution of Dr. Paz Soldan has received research support from Western Institute for Biomedical Research. The institution of Dr. Paz Soldan has received research support from Biogen. The institution of Dr. Paz Soldan has received research support from Novartis. The institution of Dr. Paz Soldan has received research support from Clene Nanomedicine.
John E. Greenlee, MD, FAAN (University of Utah)	Dr. Greenlee has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink. Dr. Greenlee has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Zeigler Cohen Roche. Dr. Greenlee has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Sommers Schwartz PC. Dr. Greenlee has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for St Francis Hospital. Dr. Greenlee has received publishing royalties from a publication relating to health care. Dr. Greenlee has received publishing royalties from a publication relating to health care.
John W. Rose, MD, FAAN (Imaging and Neurosciences Center)	The institution of Dr. Rose has received research support from National Multiple Sclerosis Society. The institution of Dr. Rose has received research support from Guthy Jackson Charitable Foundation. The institution of Dr. Rose has received research support from NIH . The institution of Dr. Rose has received research support from VA. The institution of Dr. Rose has received research support from Biogen. The institution of Dr. Rose has received research support from Friends of MS. Dr. Rose has received intellectual property interests from a discovery or technology relating to health care.
Alen Delic	Alen Delic has nothing to disclose.
Stacey Clardy, MD, PhD, FAAN (University of Utah)	Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). Dr. Clardy has received personal compensation for serving as an employee of University of Utah Health. Dr. Clardy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca/Alexion. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen/Horizon. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. Dr. Clardy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology/AAN Publications. The institution of Dr. Clardy has received research support from NIH/NINDS. The institution of Dr. Clardy has received research support from SRNA. The institution of Dr. Clardy has received research support from Alexion/AstraZeneca. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a AAN Summer Meeting CoDirector Travel and Lodging with AAN. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Travel/Lodging/Honoraria with U of Iowa, Miami, Stanford, Barrow, Beaumont Health, CCF, Emory, Penn State, Mayo Clinic, Walter Reed.

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