Xi Chen, Jiawen Xu, Jingyan Guo, Ting Ye, Baocheng Zhao, Shiming Fang, Yan Chen, Yi Dong
{"title":"A Predictive Model and Survival Analysis for Tube Feeding in ALS Patients: A Prospective Cohort Study in a Chinese ALS Clinic","authors":"Xi Chen, Jiawen Xu, Jingyan Guo, Ting Ye, Baocheng Zhao, Shiming Fang, Yan Chen, Yi Dong","doi":"10.1155/2023/1069443","DOIUrl":null,"url":null,"abstract":"<div>\n <p><i>Objectives</i>. Tube feeding is an effective way to provide nutritional support for amyotrophic lateral sclerosis (ALS) patients with severe dysphagia. Currently, the predictors of tube feeding and the survival affected by tube feeding were poorly studied in Chinese ALS patients. Therefore, we aimed to explore predictive factors and establish a prediction model to quantitatively predict the risk of tube feeding. Furthermore, we explored the survival benefit provided by tube feeding. <i>Methods</i>. In this longitudinal, prospective cohort study, we included patients diagnosed with ALS using the Awaji criteria at the ALS clinic in Huashan Hospital. Follow-up was conducted by telephone interview from January 1, 2019, to December 30, 2021, or until death. All statistical analyses were performed using R software. <i>Results</i>. Overall, 218 patients were recruited for the study. The multivariate Cox regression analysis showed a high ALSFRS-R slope (adjusted hazard ratio (aHR) = 4.94 (95% confidence interval (95% CI: 2.26-10.81), <i>p</i> < 0.001), low bulbar score (aHR = 0.81 (95% CI: 0.69-0.96), <i>p</i> = 0.01), history of ischemic stroke (aHR = 5.69 (95% CI: 1.3-24.82), <i>p</i> = 0.02), and bulbar involvement (aHR = 11.87 (95% CI: 1.42-99.31), <i>p</i> = 0.02) as independent risk factors of tube feeding. The nomogram model was established with moderate discrimination and calibration. Among 71 ALS patients with tube feeding indication, 33.8% accepted gastrostomy suggestion and 14.1% had nasogastric tube (NGT) insertion. However, gastrostomy and NGT did not accelerate disease progression (aHR = 0.57 (95% CI: 0.20-1.67), <i>p</i> = 0.31 and aHR = 1.72 (95% CI: 0.43-6.88), <i>p</i> = 0.43, respectively). <i>Conclusions</i>. We developed a nomogram that could be a prediction tool to predict individual timing of tube feeding for ALS patients. In addition, we found that gastrostomy and NGT did not affect ALS patients’ survival.</p>\n </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2023 1","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/1069443","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Neurologica Scandinavica","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/2023/1069443","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives. Tube feeding is an effective way to provide nutritional support for amyotrophic lateral sclerosis (ALS) patients with severe dysphagia. Currently, the predictors of tube feeding and the survival affected by tube feeding were poorly studied in Chinese ALS patients. Therefore, we aimed to explore predictive factors and establish a prediction model to quantitatively predict the risk of tube feeding. Furthermore, we explored the survival benefit provided by tube feeding. Methods. In this longitudinal, prospective cohort study, we included patients diagnosed with ALS using the Awaji criteria at the ALS clinic in Huashan Hospital. Follow-up was conducted by telephone interview from January 1, 2019, to December 30, 2021, or until death. All statistical analyses were performed using R software. Results. Overall, 218 patients were recruited for the study. The multivariate Cox regression analysis showed a high ALSFRS-R slope (adjusted hazard ratio (aHR) = 4.94 (95% confidence interval (95% CI: 2.26-10.81), p < 0.001), low bulbar score (aHR = 0.81 (95% CI: 0.69-0.96), p = 0.01), history of ischemic stroke (aHR = 5.69 (95% CI: 1.3-24.82), p = 0.02), and bulbar involvement (aHR = 11.87 (95% CI: 1.42-99.31), p = 0.02) as independent risk factors of tube feeding. The nomogram model was established with moderate discrimination and calibration. Among 71 ALS patients with tube feeding indication, 33.8% accepted gastrostomy suggestion and 14.1% had nasogastric tube (NGT) insertion. However, gastrostomy and NGT did not accelerate disease progression (aHR = 0.57 (95% CI: 0.20-1.67), p = 0.31 and aHR = 1.72 (95% CI: 0.43-6.88), p = 0.43, respectively). Conclusions. We developed a nomogram that could be a prediction tool to predict individual timing of tube feeding for ALS patients. In addition, we found that gastrostomy and NGT did not affect ALS patients’ survival.
期刊介绍:
Acta Neurologica Scandinavica aims to publish manuscripts of a high scientific quality representing original clinical, diagnostic or experimental work in neuroscience. The journal''s scope is to act as an international forum for the dissemination of information advancing the science or practice of this subject area. Papers in English will be welcomed, especially those which bring new knowledge and observations from the application of therapies or techniques in the combating of a broad spectrum of neurological disease and neurodegenerative disorders. Relevant articles on the basic neurosciences will be published where they extend present understanding of such disorders. Priority will be given to review of topical subjects. Papers requiring rapid publication because of their significance and timeliness will be included as ''Clinical commentaries'' not exceeding two printed pages, as will ''Clinical commentaries'' of sufficient general interest. Debate within the speciality is encouraged in the form of ''Letters to the editor''. All submitted manuscripts falling within the overall scope of the journal will be assessed by suitably qualified referees.