{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:42:24Z","timestamp":1787506944417,"version":"build-2736575974"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction\/Aims<\/jats:title>\n                    <jats:p>The impact of maintenance steroid sparing immunosuppression (SSIS) and prednisone dosage on myasthenic crisis (MC) outcomes and their effects on the development of sepsis have not been well described. This study aimed to investigate the predictive value of these variables on MC outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, multi\u2010center study examined the potential predictors of MC outcomes using univariate and multivariate analyses through mixed\u2010effect logistic regression and Cox proportional hazards regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 57 MCs that occurred in 52 patients with a median age of 55\u2009years (interquartile range [IQR]: 33\u201366), 26 of whom (45.6%) were male. Multivariate analysis showed that sepsis was associated with prolonged length of intensive care unit (ICU) stay (hazard ratio [HR] for time to discharge from the ICU: 0.27, 95% confidence interval [CI]: 0.11\u20130.71) and duration of ventilation (HR for time to extubation: 0.28, 95% CI: 0.12\u20130.67). Predictors of sepsis development were age\u2009&gt;\u200950\u2009years (odds ratio [OR]: 7.74, 95% CI: 1.29\u201346.53) and prednisone use of \u2265\u200960\u2009mg\/day during ICU stay (OR: 13.07, 95% CI: 2.17\u201386.73). The presence of maintenance SSIS at MC onset predicted a shorter length of ICU stay (HR for time to discharge from the ICU: 2.23, 95% CI: 1.13\u20134.42) and duration of ventilation (HR for time to extubation: 2.73, 95% CI: 1.37\u20135.43).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The presence of maintenance SSIS at MC onset and the prevention of sepsis are measures that could improve MC outcomes. The use of lower doses (&lt;\u200960\u2009mg\/day) of prednisone, when feasible, could mitigate the risk of sepsis in MC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mus.28475","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T10:26:22Z","timestamp":1753266382000},"page":"636-642","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictors of Outcome in Myasthenic Crisis"],"prefix":"10.1002","volume":"72","author":[{"given":"Ahmad R.","family":"Abuzinadah","sequence":"first","affiliation":[{"name":"Department of Neurology, Faculty of Medicine King Abdulaziz University  Jeddah Saudi Arabia"},{"name":"Neuromuscular Medicine Unit, King Abdulaziz University Hospital King Abdulaziz University  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5177-8283","authenticated-orcid":false,"given":"Mohammed H.","family":"Alanazy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, King Saud University Medical City and College of Medicine King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeem Shafique","family":"Butt","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Faculty of Medicine Rabigh King Abdulaziz University  Rabigh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad H.","family":"Alzabidi","sequence":"additional","affiliation":[{"name":"Department of Neurology King Abdulaziz University Hospital  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa L.","family":"Alrehaili","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine King Fahad Hospital, Ministry of Health  Madinah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laila","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"College of Medicine King Saud bin Abdulaziz University for Health Sciences  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areej Abdulrahman","family":"Bushnag","sequence":"additional","affiliation":[{"name":"Neuroscience Department King Faisal Specialist Hospital and Research Center  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussien Salem","family":"Alkully","sequence":"additional","affiliation":[{"name":"Neuroscience Department King Faisal Specialist Hospital and Research Center  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AlBaraa Ali","family":"Beck","sequence":"additional","affiliation":[{"name":"Neuroscience Department King Faisal Specialist Hospital and Research Center  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seraj","family":"Makkawi","sequence":"additional","affiliation":[{"name":"College of Medicine King Saud Bin Abdulaziz University for Health Sciences  Jeddah Saudi Arabia"},{"name":"King Abdullah International Medical Research Center  Jeddah Saudi Arabia"},{"name":"Department of Neurology Ministry of the National Guard\u2010Health Affairs  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Maglan","sequence":"additional","affiliation":[{"name":"College of Medicine King Saud Bin Abdulaziz University for Health Sciences  Jeddah Saudi Arabia"},{"name":"King Abdullah International Medical Research Center  Jeddah Saudi Arabia"},{"name":"Department of Neurology Ministry of the National Guard\u2010Health Affairs  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alanood","family":"Alsolaihim","sequence":"additional","affiliation":[{"name":"Neuroscience Center, King Faisal Specialist Hospital and Research Center  Riyadh Saudi Arabia"},{"name":"College of Medicine Alfaisal University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Alshehri","sequence":"additional","affiliation":[{"name":"Neuroscience Center, King Faisal Specialist Hospital and Research Center  Riyadh Saudi Arabia"},{"name":"College of Medicine Alfaisal University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mossaed Mohammed","family":"Alyahya","sequence":"additional","affiliation":[{"name":"Neuroscience Center, King Faisal Specialist Hospital and Research Center  Riyadh Saudi Arabia"},{"name":"College of Medicine Alfaisal University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muteb Khidhran","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"Neurology Department Prince Sultan Military Medical City  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahad Jamal","family":"Aljasir","sequence":"additional","affiliation":[{"name":"Neurology Department Prince Sultan Military Medical City  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aysha A.","family":"Alshareef","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine King Abdulaziz University  Jeddah Saudi Arabia"},{"name":"Neuromuscular Medicine Unit, King Abdulaziz University Hospital King Abdulaziz University  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0115-9457","authenticated-orcid":false,"given":"Ahmed K.","family":"Bamaga","sequence":"additional","affiliation":[{"name":"Neuromuscular Medicine Unit, King Abdulaziz University Hospital King Abdulaziz University  Jeddah Saudi Arabia"},{"name":"Department of Pediatrics, Pediatric Neurology Division, Faculty of Medicine King Abdulaziz University  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Abdulaziz","family":"Abulaban","sequence":"additional","affiliation":[{"name":"College of Medicine King Saud bin Abdulaziz University for Health Sciences  Riyadh Saudi Arabia"},{"name":"Department of Neurology King Abdulaziz Medical City, Ministry of the National Guard\u2010Health Affairs  Riyadh Saudi Arabia"},{"name":"King Abdullah International Medical Research Center  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"For the Saudi Arabia Neuromuscular and Electrodiagnostic Medicine (SANEM) Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27832"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/1941875210382918"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26114"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.48.5.1253"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-019-1384-5"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-014-1659-y"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/17562864241226745"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008688"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.1.16"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12974-022-02448-4"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181a41211"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000503961"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000201"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1289194"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1385\/NCC:3:3:213"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.4103\/nsn.nsn_175_22"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-008-9139-y"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1385\/NCC:3:3:189"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-022-02922-9"}],"container-title":["Muscle &amp; Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.28475","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T13:46:21Z","timestamp":1757943981000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.28475"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,23]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/mus.28475"],"URL":"https:\/\/doi.org\/10.1002\/mus.28475","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"value":"0148-639X","type":"print"},{"value":"1097-4598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,23]]},"assertion":[{"value":"2024-09-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}