Hypermetabolism is a deleterious prognostic factor in patients with amyotrophic lateral sclerosis. (22nd November 2017)

• Record Type: Journal Article
• Authors: Jésus, P.; Fayemendy, P.; Nicol, M.; Lautrette, G.; Sourisseau, H.; Preux, P.‐M.; Desport, J.‐C.; Marin, B.; Couratier, P.
• Is Part Of: European journal of neurology. Volume 25:Number 1(2018)
• Page Start: 97
• Page End: 104
• Publication Date: 2017-11-22
• Subjects: amyotrophic lateral sclerosis -- hypermetabolism -- nutritional status -- prognosis -- survival; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.13468
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract : Background and purpose: The aim of this study was to investigate patients with amyotrophic lateral sclerosis in order to determine their nutritional, neurological and respiratory parameters, and survival according to metabolic level. Methods: Nutritional assessment included resting energy expenditure (REE) measured by indirect calorimetry [hypermetabolism if REE variation (ΔREE) > 10%] and fat mass (FM) using impedancemetry. Neurological assessment included the Amyotrophic Lateral Sclerosis Functional Rating Scale‐Revised score. Survival analysis used the Kaplan–Meier method and multivariate Cox model. Results: A total of 315 patients were analysed. Median age at diagnosis was 65.9 years and 55.2% of patients were hypermetabolic. With regard to the metabolic level (ΔREE: < 10%, 10–20% and >20%), patients with ΔREE > 20% initially had a lower FM(29.7% vs. 32.1% in those with ΔREE ≤10%; P = 0.0054). During follow‐up, the median slope of Amyotrophic Lateral Sclerosis Functional Rating Scale‐Revised tended to worsen more in patients with ΔREE > 20% (−1.4 vs. −1.0 points/month in those with ΔREE ≤10%; P = 0.07). Overall median survival since diagnosis was 18.4 months. ΔREE > 20% tended to increase the risk of dying compared with ΔREE ≤10% (hazard ratio, 1.33; P = 0.055). In multivariate analysis, an increased REE:FM ratio was independently associated with death (hazard ratio, 1.005; P = 0.001). Conclusions: Hypermetabolism is present in more than half of patients with amyotrophic lateral sclerosis. It modifies the body composition at diagnosis, and patients with hypermetabolism >20% have a worse prognosis than those without hypermetabolism. Abstract : Clickhere to view the accompanying paper in this volume.