title: Stratification of ALS patients' survival: a population-based study.
abstract: The natural history of amyotrophic lateral sclerosis (ALS) and patient risk stratification are areas of considerable research interest. We aimed (1) to describe the survival of a representative cohort of French ALS patients, and (2) to identify covariates associated with various patterns of survival using a risk classification analysis. ALS patients recruited in the FRALim register (2000-2013) were included. Time-to-death analyses were performed using Kaplan-Meier method and Cox model. A recursive partitioning and amalgamation (RECPAM) algorithm analysis identified subgroups of patients with different patterns of survival. Among 322 patients, median survival times were 26.2 and 15.6 months from time of onset and of diagnosis, respectively. Four groups of patients were identified, depending on their baseline characteristics and survival (1) ALSFRS-R slope >0.46/month and definite or probable ALS (median survival time (MST) 10.6 months); (2) ALSFRS-R slope >0.46/month and possible or probable laboratory-supported ALS (MST: 18.1 months); (3) ALSFRS-R slope ≤0.46/month and definite or probable ALS (MST: 22.5 months), and (4) ALSFRS-R slope ≤0.46/month and possible or probable laboratory-supported ALS (MST: 37.6 months). Median survival time is among the shortest ever reported by a worldwide population-based study. This is probably related to the age structure of the patients (the oldest identified to date), driven by the underlying population (30 % of subjects older than 60 years). Further research in the field of risk stratification could help physicians better anticipate prognosis of ALS patients, and help improve the design of randomized controlled trials.
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.|Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France.|CHU Limoges, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, F-87000, Limoges, France.|Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.|Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
authors.forename: Benoît
authors.initials: B
authors.lastname: Marin
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.|Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France.|CHU Limoges, Service de Neurologie, Centre SLA, F-87000, Limoges, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Couratier
authors.affiliation: Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.|Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Arcuti
authors.affiliation: Unit of Biostatistics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Copetti
authors.affiliation: Unit of Biostatistics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fontana
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.|Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France.|CHU Limoges, Service de Neurologie, Centre SLA, F-87000, Limoges, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Nicol
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.|Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France.|CHU Limoges, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, F-87000, Limoges, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Raymondeau
authors.affiliation: Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Logroscino
authors.affiliation: INSERM, U1094, Tropical Neuroepidemiology, Limoges, France. preux@unilim.fr.|Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France. preux@unilim.fr.|CHU Limoges, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, F-87000, Limoges, France. preux@unilim.fr.
authors.forename: Pierre Marie
authors.initials: PM
authors.lastname: Preux
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors
keywords: Amyotrophic lateral sclerosis; Epidemiology; Mortality; Prognosis; Survival