Giuseppe Borghero, Vincenzo Pierri, Francesca Pili, Antonella Muroni, Tommaso Ercoli, Maria Ida Pateri, Silvy Pilotto, Alessandra Maccabeo, Adriano Chiò, Giovanni Defazio
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NIV was associated with better survival while PEG was associated with reduced survival. Other independent prognostic factors were age at ALS onset, diagnostic delay, and flail arm/leg and pure upper motor neuron (PUMN) phenotypes. The length of survival after TIV was significantly associated with age at ALS onset (inverse correlation) whereas other variables did not. The length of survival after TIV correlated to age at ALS onset in such a way that each additional year of age at ALS onset decreased survival by about 0.7 months. Patients who underwent both TIV and NIV did not experience a better survival than those who underwent TIV alone.</p><p><strong>Conclusion: </strong>The lack of effect of enteral nutrition on ALS survival probably reflected the timing of PEG insertion in patients with more severe disease. By contrast, patients who used mechanical ventilation had an increased overall survival compared with non-ventilated ones. The study also provided new information showing that the combined use of NIV and TIV did not may prolong ALS survival as compared to TIV alone.</p>","PeriodicalId":72184,"journal":{"name":"Amyotrophic lateral sclerosis & frontotemporal degeneration","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Percutaneous gastrostomy, mechanical ventilation and survival in amyotrophic lateral sclerosis: an observational study in an incident cohort.\",\"authors\":\"Giuseppe Borghero, Vincenzo Pierri, Francesca Pili, Antonella Muroni, Tommaso Ercoli, Maria Ida Pateri, Silvy Pilotto, Alessandra Maccabeo, Adriano Chiò, Giovanni Defazio\",\"doi\":\"10.1080/21678421.2024.2351185\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To analyze disease-modifying effects of percutaneous endoscopic gastrostomy (PEG) insertion for supporting nutrition, noninvasive ventilation (NIV), and tracheostomy-assisted ('invasive') ventilation (TIV) in amyotrophic lateral sclerosis (ALS).</p><p><strong>Methods: </strong>We retrospectively analyzed survival in a large population-based incident cohort that was prospectively followed up in our center. 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引用次数: 0
摘要
目的分析经皮内镜胃造瘘术(PEG)对肌萎缩侧索硬化症(ALS)患者进行营养支持、无创通气(NIV)和气管造口辅助("有创")通气(TIV)的疾病调节作用:我们回顾性分析了在本中心进行前瞻性随访的大型人群发病队列的存活率。分析考虑了几个已知的 ALS 相关预后变量:结果:在这一人群中,PEG 和 NIV 在多变量分析中与从发病到死亡/气管造口术的存活率显著相关。NIV 与较高的存活率相关,而 PEG 与较低的存活率相关。其他独立的预后因素包括 ALS 发病年龄、诊断延迟、手臂/腿部外翻和纯上运动神经元 (PUMN) 表型。TIV 后的存活时间与 ALS 发病年龄显著相关(呈反相关),而其他变量则不相关。TIV后的存活时间与ALS发病年龄相关,ALS发病年龄每增加一岁,存活时间就会减少约0.7个月。同时接受TIV和NIV治疗的患者的存活率并不比仅接受TIV治疗的患者高:结论:肠内营养对 ALS 存活率没有影响,这可能反映了在病情较严重的患者中插入 PEG 的时机。相比之下,使用机械通气的患者比不使用机械通气的患者总生存率更高。该研究还提供了新的信息,表明与单独使用 TIV 相比,联合使用 NIV 和 TIV 并不能延长 ALS 的存活时间。
Percutaneous gastrostomy, mechanical ventilation and survival in amyotrophic lateral sclerosis: an observational study in an incident cohort.
Objective: To analyze disease-modifying effects of percutaneous endoscopic gastrostomy (PEG) insertion for supporting nutrition, noninvasive ventilation (NIV), and tracheostomy-assisted ('invasive') ventilation (TIV) in amyotrophic lateral sclerosis (ALS).
Methods: We retrospectively analyzed survival in a large population-based incident cohort that was prospectively followed up in our center. Analysis considered several known ALS-related prognostic variables.
Results: In this population, PEG and NIV in multivariable analysis significantly correlated to survival as computed by disease onset to death/tracheostomy. NIV was associated with better survival while PEG was associated with reduced survival. Other independent prognostic factors were age at ALS onset, diagnostic delay, and flail arm/leg and pure upper motor neuron (PUMN) phenotypes. The length of survival after TIV was significantly associated with age at ALS onset (inverse correlation) whereas other variables did not. The length of survival after TIV correlated to age at ALS onset in such a way that each additional year of age at ALS onset decreased survival by about 0.7 months. Patients who underwent both TIV and NIV did not experience a better survival than those who underwent TIV alone.
Conclusion: The lack of effect of enteral nutrition on ALS survival probably reflected the timing of PEG insertion in patients with more severe disease. By contrast, patients who used mechanical ventilation had an increased overall survival compared with non-ventilated ones. The study also provided new information showing that the combined use of NIV and TIV did not may prolong ALS survival as compared to TIV alone.