Predictive factors for gastrostomy at time of diagnosis and impact on survival in patients with amyotrophic lateral sclerosis.

Marion Vergonjeanne, Philippe Fayemendy, Benoit Marin, Marie Penoty, Géraldine Lautrette, Huguette Sourisseau, Pierre-Marie Preux, Jean-Claude Desport, Philippe Couratier, Pierre Jésus

Journal: Clinical nutrition (Edinburgh, Scotland) 2021;39(10):3112-3118

PMID: 32063408

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Gastrostomy is recommended in patients with Amyotrophic Lateral Sclerosis (ALS) in the presence of weight loss over 10% as compared to usual weight, repeated aspirations or meal time duration longer than 45 min. Currently, the impact of gastrostomy on survival of ALS patients is not clear.

AIMS

i) to describe diagnosis factors associated with the indication for gastrostomy ii) to evaluate survival of ALS patients with gastrostomy indication according to their acceptance of feeding tube placement.

METHODS

Patients with ALS were included and followed in the ALS referral centre of Limoges's teaching hospital between 2006 and 2017. Neurological, nutritional and respiratory status was assessed prospectively from diagnosis to death. Statistical analysis was performed using Mann-Whitney test, Chi tests, Cox model and multivariate logistic regression.

RESULTS

Two hundred and eighty-five patients were included. Among the 182 for whom gastrostomy was indicated, 63.7% accepted the placement. The median time was 7.3 months [IQR: 3.2-15.0] and 2.7 months [IQR: 0.9-5.8] respectively from diagnosis to indication and from indication to placement. Weight loss >5% significantly increased the risk of death by 17% (p < 0.0001). At time of diagnosis, bulbar onset, a loss of one point in the body mass index or on the bulbar functional scale were all positively associated with indication for gastrostomy (aOR = 10.0 [95%CI: 1.96-25.0]; p = 0.002, aOR = 1.17 [95%CI: 1.02-1.36]; p = 0.025 and aOR = 1.19 [95%CI: 1.06-1.32]; p = 0.002, respectively). However, gastrostomy placement did not have any impact on survival (aHR = 1.25 [95%CI: 0.88-1.79]; p = 0.22).

CONCLUSION

Both neurological and nutritional criteria were associated with an indication for gastrostomy at diagnosis. Gastrostomy placement had no impact on survival. The study of earlier gastrostomy placement might be of interest in further prospective studies.

Address: INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France. Electronic address: [email protected].; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; CHU Limoges, Department of Nutrition, Limoges, France. Electronic address: [email protected].; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; Epidemiology, Biostatistics and Methodological Research Centre, University Hospital of Limoges, France. Electronic address: [email protected].; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; ALS Center, Neurology Department, University Hospital of Limoges, France. Electronic address: [email protected].; ALS Center, Neurology Department, University Hospital of Limoges, France. Electronic address: [email protected].; CHU Limoges, Department of Nutrition, Limoges, France. Electronic address: [email protected].; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; Epidemiology, Biostatistics and Methodological Research Centre, University Hospital of Limoges, France. Electronic address: [email protected].; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; CHU Limoges, Department of Nutrition, Limoges, France. Electronic address: [email protected].; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; ALS Center, Neurology Department, University Hospital of Limoges, France. Electronic address: [email protected].; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; CHU Limoges, Department of Nutrition, Limoges, France. Electronic address: [email protected].

DOI: 10.1016/j.clnu.2020.01.018

Link outs

Free resources

Medical:

https://medlineplus.gov/amyotrophiclateralsclerosi...

Miscellaneous:

https://assays.cancer.gov/non-CPTAC-2678

Subscription / membership required

Full Text Sources:

MeSH Terms: Aged, Amyotrophic Lateral Sclerosis, Female, France, Gastrostomy, Humans, Male, Middle Aged, Neurologic Examination, Nutrition Assessment, Nutritional Status, Predictive Value of Tests, Respiratory Aspiration of Gastric Contents, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Weight Loss