Tracheostomy in ALS.Survival and related factors

Abstract

In ALS with established respiratory failure, patients may benefit from the use of tracheostomy. There are few studies regarding the survival of these patients and related prognostic factors.

Aims: To evaluate survival and factors related to the presence of tracheostomy in ALS patients. To analyze prognostic factors for survival.

Methods: Observational and retrospective study(January 2005-February 2021)in ALS patients under follow-up by Pneumology. The following variables were recorded:age, sex,time since diagnosis, onset of symptoms, type of ALS, use of NIV, use of cough assistant, percutaneous gastrostomy, hospitalizations,days of stay and tracheostomy. Data were analyzed by Chi-square, U-Mann-Whitney, Kaplan-Meier, Spearman's Rho and Cox regression.

Results: 218 patients were included, mean age 63.4+/-12.9years, 53.1%male, 81.9%sporadic ALS and 58.4%spinal ALS.Some 5.1%had tracheostomy, associated with the use of life support ventilation[OR=14.4(95%CI 1.8-116.2)],gastrostomy[OR=15.7(95%CI 1.9-125.0)],younger age at diagnosis(47.4±14.9years),higher number of admissions(2.6±1.7)and hospital stay(85.2±118.7days)p>0.005.There were no significant differences in tracheostomy survival(32.7±11.8months)and overall cohort survival(40.8±7.8months).In the univariate and subsequent multivariate analysis, the overall survival of patients is related to age at diagnosis and bulbar onset(HR=1.05 p<0.001 and HR=1.6 p=0.028).

Conclusions: In our study, the use of tracheostomy does not improve survival over the remaining patients who refuse it. Tracheostomy is related with patients who presented continuous use of NIV, need for gastrostomy and higher number of admissions and hospital stay. Age at diagnosis and bulbar form are considered prognostic factors for survival.