Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Nov 3;16(1):136.
doi: 10.1186/s12890-016-0297-y.

Hospitalizations due to respiratory failure in patients with Amyotrophic Lateral Sclerosis and their impact on survival: a population-based cohort study

Federica Edith Pisa  1   2 , Giancarlo Logroscino  3 , Paolo Giacomelli Battiston  4 , Fabio Barbone  5   4   6
Affiliations

Hospitalizations due to respiratory failure in patients with Amyotrophic Lateral Sclerosis and their impact on survival: a population-based cohort study

Federica Edith Pisa et al. BMC Pulm Med. .

Abstract

Background: Respiratory failure, infections and aspiration pneumonia, are the main causes of morbidity and mortality in Amyotrophic Lateral Sclerosis (ALS). In a population-based cohort, we assessed (a) hospital utilization and (b) impact of hospitalization for respiratory failure on survival.

Methods: All patients with incident ALS in Friuli Venezia Giulia region, Italy, from 2002 to 2009, were identified through multiple sources. Diagnosis was validated through clinical documentation review. For each patient, we extracted the records of all hospitalizations after ALS diagnosis from the regional hospitalization database. Cox proportional hazards model survival Hazard Ratio (HR), with 95 % Confidence Interval (95 % CI), was calculated.

Results: Out of 262 patients, 98.1 % had at least 1 and 58.0 % ≥3 hospitalizations. Emergency admissions occurred in 77.5 % of patients and a diagnosis of respiratory failure in 55.0 %. Patients underwent a total of 885 hospitalizations. The leading diagnosis was respiratory failure (31.6 % of hospitalizations). This diagnosis occurred most frequently in emergency (45.6 %) than in elective admissions (26.4 %). The second leading diagnosis was pneumonia (14.2 %), 24.9 and 6.3 % respectively. The leading procedure was mechanical ventilation (18.4 %), performed in 29.9 % of emergency and in 12.4 % of elective admissions. After adjustment for site of onset, age and diagnostic delay, a first hospitalization for respiratory failure had a strong adverse effect on survival (HR 4.00; 95 % CI 3.00; 5.34).

Conclusions: Respiratory failure, pneumonia and aspiration pneumonia were major determinants of hospitalizations and emergency admissions and often dealt with in emergency admissions. A first hospitalization for respiratory failure had a strong adverse effect on survival. Strategies to improve home management of respiratory conditions in patients with ALS and to optimize hospital care utilization are needed.

Keywords: Amyotrophic Lateral Sclerosis; Cohort studies; Database research; Hospital utilization; Hospitalization; Mechanical ventilation; Non-invasive ventilation; Respiratory failure; Survival; Tracheostomy.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Kaplan-Mayer plot with 95 % Hall-Wellnerbands
See this image and copyright information in PMC

References

    1. Marin B, Logroscino G, Boumediene F, Labrunie A, Couratier P, Babron MC, Leutenegger AL, Preux PM, Beghi E. Clinical and demographic factors and outcome of amyotrophic lateral sclerosis in relation to population ancestral origin. Eur J Epidemiol. 2016;31(3):229-45. doi: 10.1007/s10654-015-0090-x. Epub 2015 Oct 12. - PubMed
    1. Chio A, Logroscino G, Hardiman O, Swingler R, Mitchell D, Beghi E, Traynor BG. Prognostic factors in ALS: A critical review. Amyotroph Lateral Scler. 2009;10(5–6):310–323. doi: 10.3109/17482960802566824. - DOI - PMC - PubMed
    1. Capozzo R, Quaranta VN, Pellegrini F, Fontana A, Copetti M, Carratu P, Panza F, Cassano A, Falcone VA, Tortelli R, et al. Sniff nasal inspiratory pressure as a prognostic factor of tracheostomy or death in amyotrophic lateral sclerosis. J Neurol. 2015;262(3):593–603. doi: 10.1007/s00415-014-7613-3. - DOI - PubMed
    1. Pena MJ, Ravasco P, Machado M, Pinto A, Pinto S, Rocha L, de Carvalho M, Pinto HC. What is the relevance of percutaneous endoscopic gastrostomy on the survival of patients with amyotrophic lateral sclerosis? Amyotroph Lateral Scler. 2012;13(6):550–554. doi: 10.3109/17482968.2012.684215. - DOI - PubMed
    1. Andersen PM, Abrahams S, Borasio GD, de Carvalho M, Chio A, Van Damme P, Hardiman O, Kollewe K, Morrison KE, Petri S, et al. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)—revised report of an EFNS task force. Eur J Neurol. 2012;19(3):360–375. doi: 10.1111/j.1468-1331.2011.03501.x. - DOI - PubMed