Xiao Dong, Daji Chen, Linlin Wan, Linliu Peng, Zhao Chen, Riwei Ouyang, Xiafei Long, Kefang Du, Xiaokang Wu, Xinying Xiao, Ruqing He, Rong Qiu, Beisha Tang, Hong Jiang
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引用次数: 0
Abstract
Background: Multiple-system atrophy is a rapidly progressive neurodegenerative disease with incomplete survival data, limiting the understanding of long-term outcomes. This study aimed to investigate a comprehensive data including survival time and prognostic factors.
Methods: Individual patient data were pooled from studies reporting Kaplan-Meier curves, and then, survival curves were generated. The pooled median survival times were derived using weighted median of medians approach and hazard ratios of risk factors were analyzed using either fixed- or random-effects model.
Results: 37 studies involving 6145 patients were included. The median survival time for MSA patients was 8.23 years (95% CI 8.02-8.56) based on reconstructed individual patient data. The pooled weighted median time was 8.0 years (95% CI 7.51-9.0). The following variables were found as unfavorable prognostic factors (hazard ratio with 95% CI are shown): age at onset (1.02, 1.01-1.03), poor levodopa response (1.55, 1.14-2.11), parkinsonism onset (1.30, 1.05-1.62), falls (1.84, 1.4-2.4), dysautonomia onset (1.48, 1.16-1.9), autonomic failure (2.52, 1.42-4.48), orthostatism hypotension (1.39, 1.16-1.66), bladder catheterization (1.81, 1.41-2.31), and stridor (1.5, 1.12-2.02).
Conclusion: Survival time in MSA was evaluated using multiple methodological approaches, revealing a median survival of 8.0 years, and clinical variables like early autonomic failure and frequently falls were identified as predictors of poor survival outcomes.
背景：多系统萎缩是一种快速进展的神经退行性疾病，其生存数据不完整，限制了对长期预后的理解。本研究旨在调查包括生存时间和预后因素在内的综合数据。方法：从报告Kaplan-Meier曲线的研究中汇总个体患者数据，然后生成生存曲线。合并中位生存时间采用加权中位数法得出，危险因素的风险比采用固定效应或随机效应模型进行分析。结果：纳入37项研究，涉及6145例患者。根据重建的个体患者数据，MSA患者的中位生存时间为8.23年（95% CI 8.02-8.56）。合并加权中位时间为8.0年（95% CI 7.51-9.0）。以下变量被认为是不利的预后因素（显示95% CI的危险比）：发病年龄（1.02,1.01-1.03），左旋多巴反应差（1.55,1.14-2.11），帕金森病发病（1.30,1.05-1.62），跌倒（1.84,1.4-2.4），自主神经异常发病（1.48,1.16-1.9），自主神经衰竭（2.52,1.42-4.48），直立性低血压（1.39,1.16-1.66），膀胱导尿（1.81,1.41-2.31），喘鸣（1.5,1.12-2.02）。结论：采用多种方法评估MSA患者的生存时间，显示中位生存期为8.0年，早期自主神经衰竭和频繁跌倒等临床变量被确定为不良生存结果的预测因素。
期刊介绍：
The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field.
In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials.
Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.
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