Survival of patients with ALS following institution of enteral feeding is related to pre-procedure oximetry: a retrospective review of 98 patients in a single centre.
A retrospective review was carried out on the influence of pre-procedure respiratory assessment on survival of patients with amyotrophic lateral sclerosis (ALS) requiring nutritional support with either a gastrostomy or a nasogastric feeding tube. Over a five-year period 98 patients (49 male, 49 female; median age 61 years, range 26-86 years) with ALS were referred for enteral feeding with either radiological inserted gastrostomy (RIG), percutaneous endoscopic gastrostomy (PEG) or nasogastric tube (NG). Case notes review was performed to record patient age, sex, pre-procedure respiratory assessment, method of enteral feeding and survival post-procedure. Kaplan-Meier survival curves were constructed for each group, with Cox regression analyses performed in order to establish the effect of each variable on outcome. Median survival (with 95% confidence intervals) following RIG, PEG and NG was 6.31 months (4.58-8.04 months), 7.13 months (4.81-9.45 months) and 0.95 months (0.00-2.77 months), respectively. The survival advantage between RIG and PEG was not statistically significant (p = 0.50), but for NG versus RIG and PEG groups combined, there was a significant difference (p = 0.03). For patients with normal overnight oximetry, median survival was 8.54 months (3.88-13.21 months), compared to 4.80 months (1.20-8.39 months) in the abnormal oximetry group (p = 0.03; relative risk 1.97). It is concluded that RIG and PEG are equivalent in terms of post-procedure survival. Abnormal oximetry prior to the procedure is a significant indicator of post-procedure survival.
Department of Radiology, King's College Hospital, London, UK.
Ashley S
AS
Shaw
Mary-Ann
MA
Ampong
Alan
A
Rio
Ammar
A
Al-Chalabi
Maria E K
ME
Sellars
Catherine
C
Ellis
Christopher E
CE
Shaw
Nigel P
NP
Leigh
Paul S
PS
Sidhu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D015897:Comorbidity; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D044342:Malnutrition / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D008875:Middle Aged; D010092:Oximetry / Q000706:statistics & numerical data*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate