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

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...

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Autores principales:	Wei-Ming Su, Yang-Fan Cheng, Zheng Jiang, Qing-Qing Duan, Tian-Mi Yang, Hui-Fang Shang, Yong-Ping Chen
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Amyotrophic lateral sclerosis Survival Outcome Predictors Hazard ratios Medicine R Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/6c6a3803ff254739af9b2ca9957b30c5
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spelling	oai:doaj.org-article:6c6a3803ff254739af9b2ca9957b30c52021-12-04T04:34:42ZPredictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis2352-396410.1016/j.ebiom.2021.103732https://doaj.org/article/6c6a3803ff254739af9b2ca9957b30c52021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352396421005260https://doaj.org/toc/2352-3964Background: 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. Funding: This study was supported by the National Natural Science Fund of China (Grant No. 81971188), the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant No. 2019HXFH046), and the Science and Technology Bureau Fund of Sichuan Province (No. 2019YFS0216).Wei-Ming SuYang-Fan ChengZheng JiangQing-Qing DuanTian-Mi YangHui-Fang ShangYong-Ping ChenElsevierarticleAmyotrophic lateral sclerosisSurvivalOutcomePredictorsHazard ratiosMedicineRMedicine (General)R5-920ENEBioMedicine, Vol 74, Iss , Pp 103732- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Amyotrophic lateral sclerosis Survival Outcome Predictors Hazard ratios Medicine R Medicine (General) R5-920
spellingShingle	Amyotrophic lateral sclerosis Survival Outcome Predictors Hazard ratios Medicine R Medicine (General) R5-920 Wei-Ming Su Yang-Fan Cheng Zheng Jiang Qing-Qing Duan Tian-Mi Yang Hui-Fang Shang Yong-Ping Chen Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis
description	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. Funding: This study was supported by the National Natural Science Fund of China (Grant No. 81971188), the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant No. 2019HXFH046), and the Science and Technology Bureau Fund of Sichuan Province (No. 2019YFS0216).
format	article
author	Wei-Ming Su Yang-Fan Cheng Zheng Jiang Qing-Qing Duan Tian-Mi Yang Hui-Fang Shang Yong-Ping Chen
author_facet	Wei-Ming Su Yang-Fan Cheng Zheng Jiang Qing-Qing Duan Tian-Mi Yang Hui-Fang Shang Yong-Ping Chen
author_sort	Wei-Ming Su
title	Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis
title_short	Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis
title_full	Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis
title_fullStr	Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis
title_full_unstemmed	Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis
title_sort	predictors of survival in patients with amyotrophic lateral sclerosis: a large meta-analysis
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/6c6a3803ff254739af9b2ca9957b30c5
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Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis

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