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Aging and disease    2018, Vol. 9 Issue (1) : 102-108     DOI: 10.14336/AD.2017.0711
Orginal Article |
Causes of Death in Chinese Patients with Multiple System Atrophy
Zhang LingYu1, Cao Bei1, Zou Yutong2, Wei Qian-Qian1, Ou RuWei1, Liu Wanglin1, Zhao Bi1, Yang Jing1, Wu Ying1, Shang HuiFang1,*
1Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
2West China School of Medicine, Sichuan University, 610041, Chengdu, Sichuan, China
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The objective of this study was to explore the causes of death in Chinese patients with multiple system atrophy (MSA) as well as differences in the cause of death according to sex, subtype, disease onset, and whether the disease was accompanied by nocturnal stridor. A total of 131 MSA patients were enrolled and followed up once every year until their deaths. Clinical information was collected by neurologists, and the cause of death of the MSA patients was obtained from the patients’ relatives or caregivers. The current study included 62 MSA with predominant parkinsonism (MSA-P) and 69 MSA with predominant cerebellar ataxia (MSA-C) patients. Median survival time from disease onset to death of the MSA patients was 5.59 years. The most common cause of death was respiratory infection (65.6%). The second most common cause of death was sudden death (14.5%). Other causes included nutritional disorder due to dysphagia (9.2%), urinary tract infection (3.1%), suicide (2.3%), choking (1.5%), cerebrovascular accident (1.5%), myocardial infarction (1.5%), and lymphoma (0.8%). We found that sudden death was more likely to occur in patients with nocturnal stridor than in those without (P<0.001). There were no significant differences in the cause of death according to subtype, sex, or onset symptoms (autonomic failure or motor symptoms). Sudden death is a relatively common cause of death in MSA patients, second only to respiratory infection, especially in patients with nocturnal stridor. The information provided by our study may help to provide better medical care to MSA patients.

Keywords multiple system atrophy      cause of death      nocturnal stridor     
Corresponding Authors: Shang HuiFang   
About author:

These authors equally contributed to this work.

Issue Date: 01 February 2018
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Zhang LingYu
Cao Bei
Zou Yutong
Wei Qian-Qian
Ou RuWei
Liu Wanglin
Zhao Bi
Yang Jing
Wu Ying
Shang HuiFang
Cite this article:   
Zhang LingYu,Cao Bei,Zou Yutong, et al. Causes of Death in Chinese Patients with Multiple System Atrophy[J]. Aging and disease, 2018, 9(1): 102-108.
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Diagnosis (MSA-P/MSA-C)62/69(47.3%/52.7%)
Sex (male/female)73/58(55.7%/44.3%)
Age of onset56.94 ± 7.50
Disease duration5.61 ± 1.77
Age of death62.55 ± 7.50
Table 1  Demographic and clinical characteristics of the patients with MSA.
Cause of deathTotal (131)
N (%)
Female (58)
N (%)
Male (73)
N (%)
P-value#MSA-C (69)
N (%)
MSA-P (62)
N (%)
Respiratory infection86(65.6)38(65.5)48(65.8)0.97741(59.4)45(72.6)0.113
Urinary tract infection4(3.1)2(3.4)2(2.7)1.0003(4.3)1(1.6)0.689
Nutritional disorder12(9.2)8(13.8)4(5.5)0.1018(11.6)4(6.5)0.308
Cerebrovascular accident2(1.5)0(0.0)2(2.7)0.5031(1.4)1(1.6)1.000
Myocardial infarction2(1.5)0(0.0)2(2.7)0.5032(2.9)0(0.0)0.498
Sudden death19(14.5)9(15.5)10(13.7)0.7699(13.0)10(16.1)0.617
Table 2  Cause of death of MSA patients according to gender and subtype.
Figure 1.  Kaplan-Meier survival curve of the 131 MSA patients

Median survival from symptom onset to death was 5.59 years.

Cause of deathTotal (131)
N (%)
Autonomic failure
(81) N (%)
Cerebellar ataxia or
parkinsonism (50) N (%)
Respiratory infection86(65.6)50(61.7)36(72.0)0.229
Urinary tract infection4(3.1)4(4.9)0(0.0)0.283
Nutritional disorder12(9.2)9(11.1)3(6.0)0.501
Cerebrovascular accident2(1.5)2(2.5)0(0.0)0.524
Myocardial infarction2(1.5)0(0.0)2(4.0)0.144
Sudden death19(14.5)12(14.8)7(14.0)0.898
Table 3  Cause of death of MSA patients according to disease onset.
Cause of deathTotal (131)
N (%)
Nocturnal stridor
No (110)
N (%)
Yes (21)
N (%)
Respiratory infection86(65.6)78(70.9)8(38.1)0.004*
Urinary tract infection4(3.1)4(3.6)0(0.0)1.000
Nutritional disorder12(9.2)8(7.3)4(19.0)0.193
Cerebrovascular accident2(1.5)2(1.8)0(0.0)1.000
Myocardial infarction2(1.5)2(1.8)0(0.0)1.000
Sudden death19(14.5)10(9.1)9(42.9)0.000*
Table 4  Cause of death of MSA patient according to whether the disease was accompanied by nocturnal stridor.
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