4.7 Article

Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis

期刊

EBIOMEDICINE
卷 74, 期 -, 页码 -

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ELSEVIER
DOI: 10.1016/j.ebiom.2021.103732

关键词

Amyotrophic lateral sclerosis; Survival; Outcome; Predictors; Hazard ratios

资金

  1. National Natural Science Fund of China [81971188]
  2. 1.3.5 project for disciplines of excel-lence, West China Hospital, Sichuan University [2019HXFH046]
  3. Science and Technology Bureau Fund of Sichuan Province [2019YFS0216]

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This study conducted a comprehensive meta-analysis on non-genetic prognostic and survival factors in ALS patients, identifying several prediction factors associated with ALS survival. These findings will aid in the development of treatment strategies for ALS.
Background: The survival time of amyotrophic lateral sclerosis (ALS) is greatly variable and protective or risk effects of the potential survival predictors are controversial. Thus, we aim to undertake a comprehensive meta-analysis of studies investigating non-genetic prognostic and survival factors in patients with ALS. Methods: A search of relevant literature from PubMed, Embase, Cochrane library and other citations from 1st January 1966 to 1st December 020 was conducted. Random-effects models were conducted to pool the multivariable or adjusted hazard ratios (HR) by Stata MP 16.0. PROSPERO registration number: CRD42021256923. Findings: A total of 5717 reports were identified, with 115 studies meeting pre-designed inclusion criteria involving 55,169 ALS patients. Five dimensions, including demographic, environmental or lifestyle, clinical manifestations, biochemical index, therapeutic factors or comorbidities were investigated. Twenty-five prediction factors, including twenty non-intervenable and five intervenable factors, were associated with ALS survival. Among them, NFL (HR:3.70, 6.80, in serum and CSF, respectively), FTD (HR:2.98), ALSFRS-R change (HR:2.37), respiratory subtype (HR:2.20), executive dysfunction (HR:2.10) and age of onset (HR:1.03) were superior predictors for poor prognosis, but pLMN or pUMN (HR:0.32), baseline ALSFRS-R score (HR:0.95), duration (HR:0.96), diagnostic delay (HR:0.97) were superior predictors for a good prognosis. Our results did not support the involvement of gender, education level, diabetes, hypertension, NIV, gastrostomy, and statins in ALS survival. Interpretation: Our study provided a comprehensive and quantitative index for assessing the prognosis for ALS patients, and the identified non-intervenable or intervenable factors will facilitate the development of treatment strategies for ALS. (C) 2021 The Author(s). Published by Elsevier B.V.

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