Prognosis of amyotrophic lateral sclerosis patients after tracheostomy invasive ventilation in Korea

Abstract

Background: Tracheostomy invasive ventilation (TIV) is applied to a subset of amyotrophic lateral sclerosis (ALS) patients; however, its frequency and impact on prognosis vary across countries. Methods: We conducted a nationwide retrospective cohort study using Korean National Health Insurance claims data. All patients diagnosed with sporadic ALS from 2012 to 2017 were included, with the observation period until 2020. The survival time between the TIV and non-TIV groups was compared using propensity score matching analysis, and prognostic factors were assessed within the TIV group. Results: This study included 3484 ALS patients (mean [standard deviation] age, 62.4 [11.9] years, 60.4% male), among whom 1230 (35.3%) underwent TIV. After 1:1 propensity score matching, the survival duration between the two groups was not significantly different (28 vs. 25 months, p = 0.057). Cox regression indicated that older age (hazard ratios [HRs] for each decade compared to <40 years: 3.89, 3.83, 5.30, 6.78, and 8.40 [$\ge$80 years]; p < 0.005 for all) and lower income (HR, 1.28; 95% confidence interval [CI], 1.09–1.52; p = 0.003) negatively impacted survival, while gastrostomy (HR, 0.57; 95% CI, 0.50–0.66; p < 0.001) and supportive care services (HR, 0.43; 95% CI, 0.32–0.59; p < 0.001) were associated with prolonged survival. Conclusions: TIV was administered to more than one-third of Korean ALS patients without significant survival prolongation. Older age, lower income, lack of gastrostomy, and insufficient supportive care were independent poor prognostic factors for survival, underscoring the importance of comprehensive management for ALS patients.

Keywords:

• Amyotrophic lateral sclerosis
• tracheostomy
• prognosis
• survival

Authors’ contribution

Study concept and design: SJC, JSK. Data acquisition, analysis, or interpretation of data: SJC, JSK, MP, SP. Statistical analysis: MP, SP. Drafting the manuscript: SJC, JSK. Critical revision of the manuscript for important intellectual content: SJC, JSK, JC, YHH, KSP, JJS. Funding acquisition: JJS, SJC. Supervision: JJS, SJC

Acknowledgments

We would like to acknowledge the National Health Insurance Service (NHIS) of Korea for providing access to the database. The dataset utilized in our research is derived from the NHIS customized health information data (NHIS-2022-1-006), generated by the NHIS.

Data availability statement

No data are available. These data have certain limitations and access restrictions due to the licensing agreement in place for this study.

Declaration of statement

The authors declare that there is no conflict of interest regarding the publication of this article.

Ethical approval

This study was approved by the Institutional Review Board of Seoul National University Hospital (No. 2106-025-1224).

Additional information

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (2020R1C1C1005122 and 2018R1A5A2025964).