High neutrophil-to-lymphocyte ratio predicts short survival duration in amyotrophic lateral sclerosis

ObjectiveTo investigate somatosensory cortex excitability and its relationship to survival prognosis in patients with amyotrophic lateral sclerosis (ALS).MethodsA total of 145 patients with sporadic ALS and 73 healthy control participants were studied. We recorded compound muscle action potential and sensory nerve action potential of the median nerve and the median nerve somatosensory evoked potential (SEP), and we measured parameters, including onset-to-peak amplitude of N13 and N20 and peak-to-peak amplitude between N20 and P25 (N20p-P25p). Clinical prognostic factors, including ALS Functional Rating Scale–Revised, were evaluated. We followed up patients until the endpoints (death or tracheostomy) and analyzed factors associated with survival using multivariate analysis in the Cox proportional hazard model.ResultsCompared to controls, patients with ALS showed a larger amplitude of N20p-P25p in the median nerve SEP. Median survival time after examination was shorter in patients with N20p-P25p ≥8 μV (0.82 years) than in those with N20p-P25p <8 μV (1.68 years, p = 0.0002, log-rank test). Multivariate analysis identified a larger N20p-P25p amplitude as a factor that was independently associated with shorter survival (p = 0.002).ConclusionSensory cortex hyperexcitability predicts short survival in patients with ALS.

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Associations of Patient Mood, Modulators of Quality of Life, and Pharmaceuticals with Amyotrophic Lateral Sclerosis Survival Duration

Behavioral Sciences ◽

10.3390/bs10010033 ◽

2020 ◽

Vol 10 (1) ◽

pp. 33 ◽

Cited By ~ 2

Author(s):

Leila Bond ◽

Gloria Bowen ◽

Benjamin Mertens ◽

Keelie Denson ◽

Kathleen Jordan ◽

...

Keyword(s):

Quality Of Life ◽

Amyotrophic Lateral Sclerosis ◽

Random Forests ◽

Muscle Relaxants ◽

Survival Duration ◽

Clinical Impression ◽

Physical Factors ◽

Exact Test ◽

Lateral Sclerosis

Associations of modulators of quality of life (QoL) and survival duration are assessed in the fatal motor neuron disease, Amyotrophic Lateral Sclerosis. Major categories include clinical impression of mood (CIM); physical health; patient social support; and usage of interventions, pharmaceuticals, and supplements. Associations were assessed at p < 0.05 and p < 0.001 significance thresholds using applicable methods (Chi-square, t-test, ANOVA, logistical regression, random forests, Fisher’s exact test) within a retrospective cohort of 1585 patients. Factors significantly correlated with positive (happy or normal) mood included family support and usage of bi-level positive airway pressure (Bi-PAP) and/or cough assist. Decline in physical factors like presence of dysphagia, drooling, general pain, and decrease in ALSFRS-R total score or forced vital capacity (FVC) significantly correlated with negative (depressed or anxious) mood (p < 0.05). Use of antidepressants or pain medications had no association with ALS patient mood (p > 0.05), but were significantly associated with increased survival (p < 0.05). Positive patient mood, Bi-PAP, cough assist, percutaneous endoscopic gastrostomy (PEG), and accompaniment to clinic visits associated with increased survival duration (p < 0.001). Of the 47 most prevalent pharmaceutical and supplement categories, 17 associated with significant survival duration increases ranging +4.5 to +16.5 months. Tricyclic antidepressants, non-opioids, muscle relaxants, and vitamin E had the highest associative increases in survival duration (p < 0.05). Random forests, which examined complex interactions, identified the following pharmaceuticals and supplements as most predictive to survival duration: Vitamin A, multivitamin, PEG supplements, alternative herbs, antihistamines, muscle relaxants, stimulant laxatives, and antispastics. Statins, metformin, and thiazide diuretics had insignificant associations with decreased survival.

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Body Fat Percentage and Availability of Oral Food Intake: Prognostic Factors and Implications for Nutrition in Amyotrophic Lateral Sclerosis

Nutrients ◽

10.3390/nu13113704 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3704

Author(s):

Jin-Woo Park ◽

Minseok Kim ◽

Seol-Hee Baek ◽

Joo Hye Sung ◽

Jae-Guk Yu ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Prognostic Factors ◽

Food Intake ◽

Body Mass ◽

Body Fat ◽

Independent Effect ◽

Survival Duration ◽

Body Fat Percentage ◽

Fat Percentage ◽

Lateral Sclerosis

Adequate nutritional support and high body mass index (BMI) are good prognostic factors for disease progression and survival in amyotrophic lateral sclerosis (ALS). However, whether the composition of body weight, such as body fat percentage, has an independent effect on ALS prognosis remains unclear. The clinical data of 53 ALS patients were collected by medical record review. The data included: disease onset, sex, age, time of diagnosis, survival duration, presence of percutaneous endoscopic gastrostomy (PEG), nasogastric tube, tracheostomy, and availability of oral intake throughout the course of the disease, and interval measurement values of body mass by bioelectrical impedance analysis (BIA). The interval change (∆) of the BIA parameters was calculated by subtracting the follow-up values from the baseline values. Change in body fat percentage/interval between BIA measurements (months) (hazard ratio [HR] = 0.374, p = 0.0247), and availability of oral food intake (HR = 0.167, p = 0.02), were statistically significant for survival duration in multivariate hazard proportional regression analysis. Survival analysis and Kaplan–Meier curves showed similar results. Higher average monthly change in body fat percentage and availability of oral food intake are prognostic factors in ALS survival.

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A Comprehensive Examination of Percutaneous Endoscopic Gastrostomy and Its Association with Amyotrophic Lateral Sclerosis Patient Outcomes

Brain Sciences ◽

10.3390/brainsci9090223 ◽

2019 ◽

Vol 9 (9) ◽

pp. 223 ◽

Cited By ~ 7

Author(s):

Leila Bond ◽

Paulamy Ganguly ◽

Nishad Khamankar ◽

Nolan Mallet ◽

Gloria Bowen ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Percutaneous Endoscopic Gastrostomy ◽

Meta Analysis ◽

Amyotrophic Lateral Sclerosis Patient ◽

Feeding Tube ◽

Survival Duration ◽

Clinical Impression ◽

Endoscopic Gastrostomy ◽

The Impact ◽

Lateral Sclerosis

There is literature discord regarding the impact of percutaneous endoscopic gastrostomy (PEG), or “feeding tube”, on amyotrophic lateral sclerosis (ALS) outcomes. We assess one of the largest retrospective ALS cohorts to date (278 PEG users, 679 non-users). Kruskal–Wallis and Kaplan–Meier analysis compared cohort medians and survival duration trends. A meta-analysis determined the aggregate associative effect of PEG on survival duration by combining primary results with 7 published studies. Primary results (p < 0.001) and meta-analysis (p < 0.05) showed PEG usage is associated with an overall significant increase in ALS survival duration, regardless of onset type. Percent predicted forced vital capacity (FVC %predict) ≥50 at PEG insertion significantly increases survival duration (p < 0.001); FVC %predict ≥60 has the largest associative benefit (+6.7 months, p < 0.05). Time elapsed from ALS onset until PEG placement is not predictive (p > 0.05). ALSFRS-R survey assessment illustrates PEG usage does not slow functional ALS pathology (p > 0.05), but does stabilize weight and/or body mass index (BMI) (p < 0.05). Observed clinical impression of mood (CIM), was not impacted by PEG usage (p > 0.05). Overall results support PEG as a palliative intervention for ALS patients with ≥50 FVC %predict at PEG insertion.

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Decreased serum creatinine levels predict short survival in amyotrophic lateral sclerosis

Annals of Clinical and Translational Neurology ◽

10.1002/acn3.51299 ◽

2021 ◽

Vol 8 (2) ◽

pp. 448-455

Author(s):

Qi‐Fu Guo ◽

Wei Hu ◽

Liu‐Qing Xu ◽

Hao Luo ◽

Ning Wang ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Serum Creatinine ◽

Short Survival ◽

Lateral Sclerosis

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Associative Increases in Amyotrophic Lateral Sclerosis Survival Duration With Non-invasive Ventilation Initiation and Usage Protocols

Frontiers in Neurology ◽

10.3389/fneur.2018.00578 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 10

Author(s):

Nishad Khamankar ◽

Grant Coan ◽

Barry Weaver ◽

Cassie S. Mitchell

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Survival Duration ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Lateral Sclerosis

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Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of worse survival after resection in patients with brain metastasis

Journal of Neurosurgery ◽

10.3171/2016.8.jns16899 ◽

2017 ◽

Vol 127 (2) ◽

pp. 433-437 ◽

Cited By ~ 17

Author(s):

Koichi Mitsuya ◽

Yoko Nakasu ◽

Takeshi Kurakane ◽

Nakamasa Hayashi ◽

Hideyuki Harada ◽

...

Keyword(s):

Brain Metastases ◽

Survival Data ◽

Tumor Resection ◽

Neutrophil To Lymphocyte Ratio ◽

Survival Duration ◽

Cancer Center ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Clinical Records ◽

The Impact

OBJECTIVEThe median postoperative survival duration of patients with brain metastases who undergo tumor resection is 12 months. Most of these patients die of systemic metastases or the progression of primary cancer but not brain metastases. The criteria for indicating resection are still controversial. Systemic assessment is restricted, especially in patients who need emergent management for their large-size or life-threatening brain metastases. The neutrophil-to-lymphocyte ratio (NLR) is reported to correlate with survival time or progression-free survival in patients with various cancers. However, NLR has not been assessed in patients with brain metastases. The impact of NLR on the survival data of patients who had undergone resection of brain metastases was retrospectively analyzed.METHODSThe clinical records of patients who underwent resection of brain metastases at Shizuoka Cancer Center between May 2007 and January 2015 were retrospectively analyzed. NLR was calculated by using the data obtained from the latest examination before resection and before the administration of steroid therapy. Kaplan-Meier curves were used for the assessment of overall survival (OS).RESULTSOf the 105 patients included, 67 patients were male. The median age of the patients was 63 years (range 36–90 years). The primary cancers were lung, colon, breast, uterus, and other cancers in 48, 19, 10, 8, and 20 patients, respectively. The postresection median survival duration was 12 months (range 1–91 months) for the entire series. The optimum NLR threshold value was identified as 5. A significant difference in the median OS was found: 14 months for 82 patients with an NLR < 5 versus 5 months for 23 patients with an NLR ≥ 5 (p = 0.001).CONCLUSIONSIn this study, an elevated preoperative NLR is a predictor of worse survival after resection for brain metastases. NLR is a simple, systemic marker and can be used in clinical settings for decision making regarding resection in patients with brain metastases.

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Epidemiology and Clinical Description of Amyotrophic Lateral Sclerosis in Low Income Setting: A Syndrome with Short Survival

American Journal of Psychiatry and Neuroscience ◽

10.11648/j.ajpn.s.2015030501.12 ◽

2015 ◽

Vol 3 (5) ◽

pp. 5

Author(s):

Komi Assogba

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Low Income ◽

Short Survival ◽

Clinical Description ◽

Low Income Setting ◽

Lateral Sclerosis

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Automated Acoustic Analysis of Oral Diadochokinesis to Assess Bulbar Motor Involvement in Amyotrophic Lateral Sclerosis

Journal of Speech Language and Hearing Research ◽

10.1044/2019_jslhr-19-00178 ◽

2020 ◽

Vol 63 (1) ◽

pp. 59-73 ◽

Cited By ~ 3

Author(s):

Panying Rong

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Acoustic Analysis ◽

Speaking Rate ◽

Disease Stage ◽

Healthy Controls ◽

Tongue Movement ◽

Major Barrier ◽

Syllable Repetition ◽

Oral Diadochokinesis ◽

Lateral Sclerosis

Purpose The purpose of this article was to validate a novel acoustic analysis of oral diadochokinesis (DDK) in assessing bulbar motor involvement in amyotrophic lateral sclerosis (ALS). Method An automated acoustic DDK analysis was developed, which filtered out the voice features and extracted the envelope of the acoustic waveform reflecting the temporal pattern of syllable repetitions during an oral DDK task (i.e., repetitions of /tɑ/ at the maximum rate on 1 breath). Cycle-to-cycle temporal variability (cTV) of envelope fluctuations and syllable repetition rate (sylRate) were derived from the envelope and validated against 2 kinematic measures, which are tongue movement jitter (movJitter) and alternating tongue movement rate (AMR) during the DDK task, in 16 individuals with bulbar ALS and 18 healthy controls. After the validation, cTV, sylRate, movJitter, and AMR, along with an established clinical speech measure, that is, speaking rate (SR), were compared in their ability to (a) differentiate individuals with ALS from healthy controls and (b) detect early-stage bulbar declines in ALS. Results cTV and sylRate were significantly correlated with movJitter and AMR, respectively, across individuals with ALS and healthy controls, confirming the validity of the acoustic DDK analysis in extracting the temporal DDK pattern. Among all the acoustic and kinematic DDK measures, cTV showed the highest diagnostic accuracy (i.e., 0.87) with 80% sensitivity and 94% specificity in differentiating individuals with ALS from healthy controls, which outperformed the SR measure. Moreover, cTV showed a large increase during the early disease stage, which preceded the decline of SR. Conclusions This study provided preliminary validation of a novel automated acoustic DDK analysis in extracting a useful measure, namely, cTV, for early detection of bulbar ALS. This analysis overcame a major barrier in the existing acoustic DDK analysis, which is continuous voicing between syllables that interferes with syllable structures. This approach has potential clinical applications as a novel bulbar assessment.

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