Sniff nasal inspiratory pressure as a prognostic factor of tracheostomy or death in amyotrophic lateral sclerosis
| Autor: | Rosanna Tortelli, Giancarlo Logroscino, Francesco Panza, Rosa Capozzo, Vitaliano Nicola Quaranta, Massimiliano Copetti, Vito Antonio Falcone, Fabio Pellegrini, Andrea Fontana, Anna Cassano, Isabella Laura Simone, Rosa Cortese, Onofrio Resta, Pierluigi Carratù |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Vital capacity medicine.medical_specialty Vital Capacity Statistics Nonparametric FEV1/FVC ratio Tracheostomy Internal medicine medicine Risk of mortality Humans Respiratory function Amyotrophic lateral sclerosis Survival analysis Aged Retrospective Studies Aged 80 and over business.industry Respiration Hazard ratio Amyotrophic Lateral Sclerosis Middle Aged medicine.disease Survival Analysis Surgery Neurology Respiratory failure Area Under Curve Female Neurology (clinical) business Respiratory Insufficiency |
| Zdroj: | Journal of neurology. 262(3) |
| ISSN: | 1432-1459 |
| Popis: | Forced vital capacity (FVC) shows limitations in detecting respiratory failure in the early phase of amyotrophic lateral sclerosis (ALS). In fact, mild-to-moderate respiratory muscle weakness may be present even when FVC is normal, and ALS patients with bulbar involvement might not be able to perform correctly the spirometry test. Sniff nasal inspiratory pressure (SNIP) is correlated with transdiaphragmatic strength. We evaluated SNIP at baseline as a prognostic factor of tracheostomy or death in patients with ALS. In a multidisciplinary tertiary care center for motorneuron disease, we enrolled 100 patients with ALS diagnosed with El Escorial criteria in the period between January 2006 and December 2010. Main outcome measures were tracheostomy or death. RECursive Partitioning and AMalgamation (RECPAM) analysis was also used to identify subgroups at different risks for the tracheostomy or death. Twenty-nine patients with ALS reached the outcome (12 died and 17 had tracheostomy). Using a multivariate model SNIP correctly classified the risk of the composite event within 1 year of follow-up with a continuous Net Reclassification Improvement cNRI of 0.58 (p = 0.03). Sex, Amyotrophic Lateral Sclerosis Functional Rating Scale revisited, site of onset, and FVC did not improve the classification of prognostic classes. SNIP ≤18 cmH2O identified the RECPAM class with the highest risk (Class 1, hazard ratio = 9.85, 95 % confidence interval: 2.67-36.29, p < 0.001). SNIP measured at baseline identified patients with ALS with initial respiratory failure. Finally, using only ALS patients with spinal onset of the disease, our findings were mostly overlapping with those reported in the models including the whole sample. At baseline, SNIP appeared to be the best predictor of death or tracheostomy within 1 year of follow-up. The measurement of SNIP in the early phase of the disease may contribute to identify patients with high risk of mortality or intubation. SNIP may also provide an additional tool for baseline stratification of patients with ALS in clinical trials. |
| Databáze: | OpenAIRE |
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