A Predictive Model and Survival Analysis for Tube Feeding in ALS Patients: A Prospective Cohort Study in a Chinese ALS Clinic

IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY
Xi Chen, Jiawen Xu, Jingyan Guo, Ting Ye, Baocheng Zhao, Shiming Fang, Yan Chen, Yi Dong
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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.

Abstract Image

ALS患者管饲的预测模型和生存分析:中国ALS临床的前瞻性队列研究
目标。管饲是为患有严重吞咽困难的肌萎缩侧索硬化症(ALS)患者提供营养支持的有效方法。目前,在中国ALS患者中,对管饲的预测因素和管饲对生存率的影响研究很少。因此,我们旨在探索预测因素,并建立一个预测模型来定量预测管饲的风险。此外,我们还探讨了管饲所带来的生存效益。方法。在这项纵向前瞻性队列研究中,我们纳入了华山医院ALS诊所使用Awaji标准诊断为ALS的患者。随访时间为2019年1月1日至2021年12月30日,或直至死亡。所有统计分析均使用R软件进行。后果总共招募了218名患者参与研究。多变量Cox回归分析显示ALSFRS-R斜率高(调整后的危险比aHR=4.94(95%置信区间(95%CI:2.26-10.81),p<0.001),延髓评分低(aHR=0.81(95%CI:0.69-0.96),p=0.01),缺血性卒中史(aHR=5.69(95%CI:1.3-24.82),p=0.02),延髓受累(aHR=11.87(95%CI:1.42-99.31),p=0.02)作为管饲的独立危险因素。建立了具有适度判别和校正的列线图模型。在71例有管饲指征的ALS患者中,33.8%接受了胃造口术建议,14.1%接受了鼻胃导管(NGT)插入。然而,胃造口术和NGT并没有加速疾病进展(aHR=0.57(95%CI:0.20-1.67),p=0.31和aHR=1.72(95%CI:0.43-6.88),p=0.43)。结论。我们开发了一个列线图,可以作为预测ALS患者管饲个体时间的预测工具。此外,我们发现胃造口术和NGT不会影响ALS患者的生存。
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来源期刊
Acta Neurologica Scandinavica
Acta Neurologica Scandinavica 医学-临床神经学
CiteScore
6.70
自引率
2.90%
发文量
161
审稿时长
4-8 weeks
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.
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