Objective: To assess clinical and neuroimaging factors associated with survival in a cohort of patients with a final clinical diagnosis of Multiple System Atrophy (MSA) according to the MDS-MSA criteria.

Background: MSA is the synucleinopathy with the poorest survival. Several studies have described clinical factors associated with a higher risk of mortality in MSA patients ^1–4. Less is known about the impact of FDG-PET findings on survival in MSA patients.

Method: We performed a retrospective longitudinal cohort study and included a total of 47 MSA patients who had been referred for an FDG-PET scan throughout the disease course . We performed a systematic review of medical records and obtained clinical and neuroimaging variables, including the date of death or last follow-up visit date in subjects who were alive in December 2022. We included the individual expression of a predefined MSA-related pattern (MSARP)⁵ obtained using a multivariate Scaled Subprofile Model/Principal Component Analysis (SSM/PCA) into FDG-PET scans. A Kaplan-Meier test was performed to calculate the median of survival. The risk of death in MSA patients was calculated using a Cox proportional hazard model in univariate analysis. We also selected variables that had previously been identified as predictors of survival and/or variables with biological plausibility. Those variables were entered into the multivariate Cox regression model.

Results: Clinical variables are described in [Table1]. MSA patients were followed up for a median of 6.1 years and a total of 15 MSA patients died (MSA-P n=9, MSA-C n =6). The median overall survival was 10.6 [8.5-14.1] years, and we did not find differences in survival between subtypes (MSA-P 9.8 [9.3-11.3] years, and  MSA-C 12 [6.6-15.8] years, p=0.911). The presence of early urinary incontinence (within the first five years of disease), a poor functional disability (SEADL<40%) at scanning, and a higher PET-FDG MSARP expression were independent risk factors of mortality [Table 2].

Conclusion: An early urinary incontinence, poor functional disability, and a more extensive MSA typical neuronal network dysfunction (MSARP expression) have a negative impact on survival.

Clinicalcs of patients with diagnosis of MSA

Survival analysis in MSA patients

References: 1. Cao B, Zhang L, Zou Y, et al. Survival analysis and prognostic nomogram model for multiple system atrophy [Internet]. Park. Relat. Disord. 2018;54(February):68–73.Available from: https://doi.org/10.1016/j.parkreldis.2018.04.016
2. Glasmacher SA, Leigh PN, Saha RA. Predictors of survival in progressive supranuclear palsy and multiple system atrophy: a systematic review and meta-analysis [Internet]. J. Neurol. Neurosurg. Psychiatry 2017;88(5):402–411.Available from: https://jnnp.bmj.com/lookup/doi/10.1136/jnnp-2016-314956
3. Du J, Cui S, Huang P, et al. Predicting the Prognosis of Multiple System Atrophy Using Cluster and Principal Component Analysis [Internet]. J. Parkinsons. Dis. 2023;13(6):937–946.Available from: https://www.medra.org/servlet/aliasResolver?alias=iospress&doi=10.3233/JPD-225127
4. Eschlboeck S, Goebel G, Eckhardt C, et al. Development and Validation of a Prognostic Model to Predict Overall Survival in Multiple System Atrophy. 2023;10(June):1368–1376.
5. Martí-Andrés,G.,etal. Abnormal pattern of brain glucose metabolism in multiple system atrophy. 25th International Congress of Parkinson ́s Disease and Movement Disorders. MDS virtual congress 2020.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-neuroimaging-factors-associated-with-survival-in-multiple-system-atrophy/