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Combining clinical and magnetic resonance imaging markers enhances prediction of 12-year employment status in multiple sclerosis patients
- Source :
- Journal of the Neurological Sciences. 388:87-93
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background Multiple sclerosis (MS) is frequently diagnosed in the most productive years of adulthood and is often associated with worsening employment status. However, reliable predictors of employment status change are lacking. Objective To identify early clinical and brain magnetic resonance imaging (MRI) markers of employment status worsening in MS patients at 12-year follow-up. Methods A total of 145 patients with early relapsing-remitting MS from the original Avonex-Steroids-Azathioprine (ASA) study were included in this prospective, longitudinal, observational cohort study. Cox models were conducted to identify MRI and clinical predictors (at baseline and during the first 12 months) of worsening employment status (patients either (1) working full-time or part-time with no limitations due to MS and retaining this status during the course of the study, or (2) patients working full-time or part-time with no limitations due to MS and switching to being unemployed or working part-time due to MS). Results In univariate analysis, brain parenchymal fraction, T1 and T2 lesion volume were the best MRI predictors of worsening employment status over the 12-year follow-up period. MS duration at baseline (hazard ratio (HR) = 1.10, 95% confidence interval (CI) 1.03–1.18; p = 0.040) was the only significant clinical predictor. Having one extra milliliter of T1 lesion volume was associated with a 53% greater risk of worsening employment status (HR = 1.53, 95% CI 1.16–2.02; p = 0.018). A brain parenchymal fraction decrease of 1% increased the risk of worsening employment status by 22% (HR = 0.78, 95% CI 0.65–0.95; p = 0.034). Conclusion Brain atrophy and lesion load were significant predictors of worsening employment status in MS patients. Using a combination of clinical and MRI markers may improve the early prediction of an employment status change over long-term follow-up.
- Subjects :
- Adult
Employment
Male
medicine.medical_specialty
Disability Evaluation
03 medical and health sciences
Multiple Sclerosis, Relapsing-Remitting
0302 clinical medicine
Atrophy
Internal medicine
medicine
Humans
Immunologic Factors
Longitudinal Studies
Prospective Studies
030212 general & internal medicine
Univariate analysis
medicine.diagnostic_test
business.industry
Proportional hazards model
Multiple sclerosis
Hazard ratio
Brain
Magnetic resonance imaging
Prognosis
medicine.disease
Magnetic Resonance Imaging
Confidence interval
Neurology
Female
Controlled Clinical Trials as Topic
Neurology (clinical)
business
030217 neurology & neurosurgery
Follow-Up Studies
Cohort study
Subjects
Details
- ISSN :
- 0022510X
- Volume :
- 388
- Database :
- OpenAIRE
- Journal :
- Journal of the Neurological Sciences
- Accession number :
- edsair.doi.dedup.....eaa113331d96d48c112faee2f0f92764