Jong-Su Kim, Minae Park, Sojeong Park, Juhee Chae, Yoon-Ho Hong, Kyung Seok Park, Jung-Joon Sung, Seok-Jin Choi
{"title":"韩国肌萎缩性脊髓侧索硬化症患者气管切开有创通气后的预后。","authors":"Jong-Su Kim, Minae Park, Sojeong Park, Juhee Chae, Yoon-Ho Hong, Kyung Seok Park, Jung-Joon Sung, Seok-Jin Choi","doi":"10.1080/21678421.2024.2314064","DOIUrl":null,"url":null,"abstract":"<p><p><i>Background</i>: Tracheostomy invasive ventilation (TIV) is applied to a subset of amyotrophic lateral sclerosis (ALS) patients; however, its frequency and impact on prognosis vary across countries. <i>Methods</i>: We conducted a nationwide retrospective cohort study using Korean National Health Insurance claims data. All patients diagnosed with sporadic ALS from 2012 to 2017 were included, with the observation period until 2020. The survival time between the TIV and non-TIV groups was compared using propensity score matching analysis, and prognostic factors were assessed within the TIV group. <i>Results</i>: This study included 3484 ALS patients (mean [standard deviation] age, 62.4 [11.9] years, 60.4% male), among whom 1230 (35.3%) underwent TIV. After 1:1 propensity score matching, the survival duration between the two groups was not significantly different (28 vs. 25 months, <i>p</i> = 0.057). Cox regression indicated that older age (hazard ratios [HRs] for each decade compared to <40 years: 3.89, 3.83, 5.30, 6.78, and 8.40 [<math><mrow><mo>≥</mo></mrow></math>80 years]; <i>p</i> < 0.005 for all) and lower income (HR, 1.28; 95% confidence interval [CI], 1.09-1.52; <i>p</i> = 0.003) negatively impacted survival, while gastrostomy (HR, 0.57; 95% CI, 0.50-0.66; <i>p</i> < 0.001) and supportive care services (HR, 0.43; 95% CI, 0.32-0.59; <i>p</i> < 0.001) were associated with prolonged survival. <i>Conclusions</i>: TIV was administered to more than one-third of Korean ALS patients without significant survival prolongation. Older age, lower income, lack of gastrostomy, and insufficient supportive care were independent poor prognostic factors for survival, underscoring the importance of comprehensive management for ALS patients.</p>","PeriodicalId":72184,"journal":{"name":"Amyotrophic lateral sclerosis & frontotemporal degeneration","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognosis of amyotrophic lateral sclerosis patients after tracheostomy invasive ventilation in Korea.\",\"authors\":\"Jong-Su Kim, Minae Park, Sojeong Park, Juhee Chae, Yoon-Ho Hong, Kyung Seok Park, Jung-Joon Sung, Seok-Jin Choi\",\"doi\":\"10.1080/21678421.2024.2314064\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><i>Background</i>: Tracheostomy invasive ventilation (TIV) is applied to a subset of amyotrophic lateral sclerosis (ALS) patients; however, its frequency and impact on prognosis vary across countries. <i>Methods</i>: We conducted a nationwide retrospective cohort study using Korean National Health Insurance claims data. All patients diagnosed with sporadic ALS from 2012 to 2017 were included, with the observation period until 2020. The survival time between the TIV and non-TIV groups was compared using propensity score matching analysis, and prognostic factors were assessed within the TIV group. <i>Results</i>: This study included 3484 ALS patients (mean [standard deviation] age, 62.4 [11.9] years, 60.4% male), among whom 1230 (35.3%) underwent TIV. After 1:1 propensity score matching, the survival duration between the two groups was not significantly different (28 vs. 25 months, <i>p</i> = 0.057). Cox regression indicated that older age (hazard ratios [HRs] for each decade compared to <40 years: 3.89, 3.83, 5.30, 6.78, and 8.40 [<math><mrow><mo>≥</mo></mrow></math>80 years]; <i>p</i> < 0.005 for all) and lower income (HR, 1.28; 95% confidence interval [CI], 1.09-1.52; <i>p</i> = 0.003) negatively impacted survival, while gastrostomy (HR, 0.57; 95% CI, 0.50-0.66; <i>p</i> < 0.001) and supportive care services (HR, 0.43; 95% CI, 0.32-0.59; <i>p</i> < 0.001) were associated with prolonged survival. <i>Conclusions</i>: TIV was administered to more than one-third of Korean ALS patients without significant survival prolongation. Older age, lower income, lack of gastrostomy, and insufficient supportive care were independent poor prognostic factors for survival, underscoring the importance of comprehensive management for ALS patients.</p>\",\"PeriodicalId\":72184,\"journal\":{\"name\":\"Amyotrophic lateral sclerosis & frontotemporal degeneration\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Amyotrophic lateral sclerosis & frontotemporal degeneration\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1080/21678421.2024.2314064\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/10 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Amyotrophic lateral sclerosis & frontotemporal degeneration","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/21678421.2024.2314064","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/10 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:气管插管有创通气(TIV)适用于一部分肌萎缩侧索硬化症(ALS)患者;然而,其使用频率和对预后的影响因国家而异。方法:我们利用韩国国民健康保险理赔数据开展了一项全国性回顾性队列研究。研究纳入了 2012 年至 2017 年确诊的所有散发性 ALS 患者,观察期至 2020 年。使用倾向得分匹配分析比较了TIV组和非TIV组的生存时间,并评估了TIV组的预后因素。研究结果该研究共纳入 3484 例 ALS 患者(平均 [标准差] 年龄为 62.4 [11.9] 岁,60.4% 为男性),其中 1230 例(35.3%)接受了 TIV 治疗。经过 1:1 倾向评分匹配后,两组患者的存活时间无明显差异(28 个月 vs. 25 个月,p = 0.057)。Cox回归表明,年龄越大(与≥80岁相比,每十年的危险比[HRs]; p p = 0.003)对存活率有负面影响,而胃造口术(HR,0.57; 95% CI,0.50-0.66; p p结论:超过三分之一的韩国 ALS 患者接受了 TIV 治疗,但存活时间并未明显延长。年龄较大、收入较低、缺乏胃造瘘术和支持性护理不足是影响存活率的独立不良预后因素,这凸显了对 ALS 患者进行综合管理的重要性。
Prognosis of amyotrophic lateral sclerosis patients after tracheostomy invasive ventilation in Korea.
Background: Tracheostomy invasive ventilation (TIV) is applied to a subset of amyotrophic lateral sclerosis (ALS) patients; however, its frequency and impact on prognosis vary across countries. Methods: We conducted a nationwide retrospective cohort study using Korean National Health Insurance claims data. All patients diagnosed with sporadic ALS from 2012 to 2017 were included, with the observation period until 2020. The survival time between the TIV and non-TIV groups was compared using propensity score matching analysis, and prognostic factors were assessed within the TIV group. Results: This study included 3484 ALS patients (mean [standard deviation] age, 62.4 [11.9] years, 60.4% male), among whom 1230 (35.3%) underwent TIV. After 1:1 propensity score matching, the survival duration between the two groups was not significantly different (28 vs. 25 months, p = 0.057). Cox regression indicated that older age (hazard ratios [HRs] for each decade compared to <40 years: 3.89, 3.83, 5.30, 6.78, and 8.40 [80 years]; p < 0.005 for all) and lower income (HR, 1.28; 95% confidence interval [CI], 1.09-1.52; p = 0.003) negatively impacted survival, while gastrostomy (HR, 0.57; 95% CI, 0.50-0.66; p < 0.001) and supportive care services (HR, 0.43; 95% CI, 0.32-0.59; p < 0.001) were associated with prolonged survival. Conclusions: TIV was administered to more than one-third of Korean ALS patients without significant survival prolongation. Older age, lower income, lack of gastrostomy, and insufficient supportive care were independent poor prognostic factors for survival, underscoring the importance of comprehensive management for ALS patients.