目的:运动神经元病(MND)是一种进行性神经退行性疾病,预期寿命有限。在胃造口术后30天内,关于死亡率及其相关因素的数据很少。我们探索了人口统计,临床,这些患者在胃造口术后30、90和180天早期死亡率的营养预测因子。
方法:这是一项回顾性研究,涉及西澳大利亚州的94名MND患者,他们在2015年至2021年之间进行了胃造口术。根据胃造口术后30、90和180天的死亡率将患者分为两组。T检验(或曼-惠特尼),卡方检验和Fisher精确检验用于检测各种因素的组间差异。多变量逻辑回归用于确定与胃造口术后90天和180天死亡率相关的因素。
结果:没有因胃造口术相关并发症导致的死亡。在胃造口术后30天内死亡的患者中,观察到从诊断到胃造口术的用力肺活量(FVC)(p=0.039)和体重减轻(%)(p=0.022)。年龄较大(p=.022),男性(p=.041),较低的FVC(p=.04),需要但不耐受无创通气(p=.035),和更大的体重减轻(%)(p=0.012)是胃造口术后90天死亡率的独立预测因子。然而,只有年龄较大(p=.01)和体重减轻较大(p=.009)是胃造口术后180天死亡率的预测因子.
结论:我们的数据表明,90天和180天的死亡率受从诊断到胃造口术的体重减轻(%)的影响,强调营养护理在MND人群中的重要性。在大幅减肥之前进行胃造口术可以降低体重减轻相关死亡率的风险,值得进一步研究。
OBJECTIVE: Motor neuron disease (MND) is a progressive neurodegenerative condition with a limited life expectancy. There is very little data on mortality and its associated factors beyond 30 days following
gastrostomy. We explored the demographic, clinical, and nutritional predictors for early mortality at 30, 90, and 180 days following gastrostomy in these patients.
METHODS: This was a retrospective study involving 94 MND patients in Western Australia who underwent gastrostomy between 2015 and 2021. Patients were divided into two groups based on mortality at 30, 90, and 180 days post-
gastrostomy. T-test (or Mann-Whitney), chi-square test and Fisher\'s exact test were used for detecting between-group differences in various factors. Multivariable logistic regression was used to identify factors associated with post-gastrostomy mortality at 90 and 180 days.
RESULTS: No mortality was attributable to
gastrostomy-related complications. Lower forced vital capacity (FVC) (p = .039) and greater weight loss (%) (p = .022) from diagnosis to gastrostomy were observed in those who died within 30 days post-
gastrostomy. Older age (p = .022), male sex (p = .041), lower FVC (p = .04), requiring but not tolerating noninvasive ventilation (p = .035), and greater weight loss (%) (p = .012) were independent predictors of 90-day post-gastrostomy mortality. However, only older age (p = .01) and greater weight loss (p = .009) were predictors of mortality at 180 days post-gastrostomy.
CONCLUSIONS: Our data indicated that mortality at 90 and 180 days was influenced by the weight loss (%) from diagnosis to gastrostomy, highlighting the importance of nutritional care in the MND population.
Gastrostomy placement prior to substantial weight loss may reduce the risk of weight loss-associated mortality and warrants further investigation.