Predictive factors for prognosis after gastrostomy placement in routine non-invasive ventilation users ALS patients

Abstract

Due to the expanding use of non-invasive ventilation (NIV) in amyotrophic lateral sclerosis (ALS), the question of enteral nutrition is increasingly raised in NIV users ALS patients. Here, we aimed to determine the prognostic factors for survival after gastrostomy placement in routine NIV users, taking into consideration ventilator dependence. Ninety-two routine NIV users ALS patients, who underwent gastrostomy insertion for severe dysphagia and/or weight loss, were included. We used a Cox proportional hazards model to identify factors affecting survival and compared time from gastrostomy to death and 30-day mortality rate between dependent (daily use ≥ 16 h) and non-dependent NIV users. The hazard of death after gastrostomy was significantly affected by 3 factors: age at onset (HR 1.047, p = 0.006), body mass index < 20 kg/m2 at the time of gastrostomy placement (HR 2.012, p = 0.016) and recurrent accumulation of airway secretions (HR 2.614, p = 0.001). Mean time from gastrostomy to death was significantly shorter in the dependent than in the non-dependent NIV users group (133 vs. 250 days, p = 0.04). The 30-day mortality rate was significantly higher in dependent NIV users (21.4% vs. 2.8%, p = 0.03). Pre-operative ventilator dependence and airway secretion accumulation are associated with worse prognosis and should be key decision-making criteria when considering gastrostomy tube placement in NIV users ALS patients.

Non-invasive ventilation support for people with amyotrophic lateral sclerosis: multidisciplinary team management

“…[12] Notably, the presence of recurrent airway secretions was independently associated with a worse prognosis, to the extent that the authors conclude this symptom should be a key decision-making criterion when considering gastrostomy placement in NIV users. [12] The Hesters et al study raises important issues for the ALS MDT. [12] Suitability for gastrostomy is often determined by respiratory function, as measured via spirometry.…”

“…[12] The Hesters et al study raises important issues for the ALS MDT. [12] Suitability for gastrostomy is often determined by respiratory function, as measured via spirometry. Symptom burden from airway secretions do not routinely form part of assessment for suitability for gastrostomy.…”

“…Hesters et al aimed to assess the prognostic factors for survival for gastrostomy placement in pwALS. Patients who were NIV dependent were found to have a significantly higher 30-day mortality risk [12]. Notably, the presence of recurrent airway secretions was independently associated with a worse prognosis, to the extent that the authors conclude this symptom should be a key decision-making criterion when considering gastrostomy placement in NIV users [12].…”

Reduction of Sniff Nasal Inspiratory Pressure (SNIP) as an Early Indicator of the Need of Enteral Nutrition in Patients with Amyotrophic Lateral Sclerosis

“…Moreover, the use of respiratory support at the time of implant is an important characteristic. The use of NIV at the time of PEG placement has in fact been reported as a negative prognostic factor for survival after PEG [44].…”

Neuroprognostication for Patients with Amyotrophic Lateral Sclerosis: An Updated, Evidence-Based Review

“…There are additional factors, specifically age of disease onset, BMI <20 kg/m 2 when the PEG is placed, and recurrent airway secretion accumulation, to consider for survival impact in patients dependent on NIV (greater than 16 hours per day) at the time of consideration of PEG placement. 100 Survival can be significantly impacted by the age of the patient at the time of disease onset, low BMI, and recurrent airway secretions.…”