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Objective: To explore the relevant factors on the prognosis of patients with multiple system atrophy (MSA). Methods: The clinical data of 85 clinically diagnosed MSA patients admitted to the Department of Neurology, First Affiliated Hospital of Air Force Military Medical University was collected from January 2016 to January 2019. These MSA patients were followed up every 6 months until they needed aid to walk. The study time limit is 3.5 years. 10 factors that may affect independent walking of MSA patients were screened for survival analysis. These factors were studied by Cox proportional hazard regression model for univariate and multivariate regression analysis. Results: In this study, there were 38 cases of probable MSA patients (44.7 %), 47 cases (55.3 %) of possible MSA patients, 43 cases (50.6 %) with Parkinson's disease-like symptoms (MSA-P), 42 cases (49.4 %) with cerebellar syndrome (MSA-C). Among them, 46 patients (54.1 %) were male, 39 patients (45.9 %) were female, with onset age of 54.7 ± 8.8 years. 30 patients (35.3 %) suffered from the onset of motor symptoms, 55 patients (64.7 %) suffered from the onset of non-motor symptoms. The median time between onset of MSA and non-motor symptoms combined with motor symptoms was 27.9 (11.5, 40.5) months. As of the end of the study, 28 patients (32.9 %) were able to walk independently, and 57 patients (67.1 %) were unable to walk independently. The median time between onset of MSA and dependent ambulation was 36.0 (22.5, 54.0) months. The Cox proportional hazard regression model suggested an old age (HR=1.041, 95 % CI 1.000 to 1.083, P=0.049), H&Y high-stage (HR=2.015, 95 % CI 1.031 to 3.938, P=0.040), short duration from onset of MSA to non-motor symptoms combined with motor symptoms (HR=0.980, 95 % CI 0.967 to 0.993, P=0.003) were independent risky factors for predicting the development of MSA patients to dependent ambulation. Conclusion: The old age, H&Y high- stage, short duration from onset of MSA to non-motor symptoms combined with motor symptoms are prognostic risk factors for MSA patients. [ABSTRACT FROM AUTHOR]