A NEWLY developed nurse-led nomogram has shown strong potential in predicting the risk of myasthenic crisis in patients with myasthenia gravis and bulbar weakness. The model, based on logistic regression, may provide frontline clinicians with an effective tool to identify patients at high risk and intervene early.
In this retrospective study, researchers analyzed 385 patients with myasthenia gravis treated between January 2022 and June 2024. The cohort was divided into a training group of 308 patients and a validation group of 77 patients. The primary endpoint was the occurrence of myasthenic crisis, a life-threatening complication characterized by respiratory failure.
Independent predictors of crisis risk included disease severity defined by the Myasthenia Gravis Foundation of America classification, the presence of thymoma, patient body position, arterial partial pressure of carbon dioxide, oxygenation index, and oropharyngeal secretions. These variables were incorporated into a visual nomogram to estimate individualized risk.
The model demonstrated robust discrimination, achieving an area under the curve of 0.806 in the training group, with sensitivity and specificity of 76.0% and 71.7%, respectively. In the validation cohort, the area under the curve rose to 0.832, with specificity exceeding 95%. Calibration analyses confirmed the accuracy of predictions, and decision curve analysis supported the model’s clinical value across a broad range of thresholds.
According to the investigators, this nurse-led nomogram may empower nursing teams to detect early warning signs of myasthenic crisis and guide proactive management strategies. However, the authors emphasize that the findings stem from a single-center retrospective study and that further multicenter validation will be essential before widespread adoption.
By providing a structured and accessible approach to individualized risk prediction, this model could represent an important advance in the clinical management of patients with myasthenia gravis.
Reference:
Dong H et al. A nurse-led nomogram for predicting the risk of myasthenic crisis in patients with myasthenia gravis and bulbar weakness. BMC Neurology. 2025;25(1):332.
