Survival of myasthenic crisis patients admitted in a tertiary referral hospital in a low to medium income country

Although some factors that increase the risk of myasthenic crisis (MC) and lower survival rates have been identified in the US and Europe, none have been studied extensively in Asian countries. This study determines the profile of MC patients admitted in a tertiary referral hospital in the Philippines and the factors possibly associated with the worst outcome, namely: survival, prolonged intubation, and tracheostomy. Data were collected from the records of MC patients admitted in the hospital, from January 1, 2014 to December 31, 2024. For survival analysis, hospital days served as time variable, mortality served as failure event, while the rest were considered censored data. Crude hazard ratios were computed for all the possible variables and those with p-value of less than 0.20 were included in the Cox regression analysis. Fifty three patients were included in the analysis. The case fatality rate of MC was 17%. At one week, around 92% of MC patients still survived which decreased to 85% at 4th week. In 2 months, this further decreased to 71%. When all possible confounders were controlled, only the number of years from diagnosis (aHR: 1.15, p = 0.032) and administration of treatment (aHR: 0.02, p = 0.015) were significantly associated with survival. In conclusion, when all possible confounders were controlled, the number of years from diagnosis was inversely while administration of immunotherapy was positively associated with survival. Nevertheless, given the small sample size, limited events, methodological constraints, the results of the study may only generate hypotheses to be tested in the future in a low to moderate income setting using a larger sample size and minimal biases.