27 February 2024 : Clinical Research
Predictors of Mortality in Veterans with Amyotrophic Lateral Sclerosis: Respiratory Status and Speech Disorder at Presentation
Meheroz H. Rabadi1ABEF*, Kimberly C. Russell1B, Chao Xu2CDDOI: 10.12659/MSM.943288
Med Sci Monit 2024; 30:e943288
Table 1 Baseline demographic information and clinical characteristics of veterans with amyotrophic lateral sclerosis (ALS) based on ALS types (mean (SD) or n (%), where applicable).
| Variables | Total (N=105) | Appendicular (N=55) | Bulbar (N=45) | Respiratory (N=5) | P-value |
|---|---|---|---|---|---|
| Age at onset (years) | |||||
| Mean (SD) | 62 (±11) | 60 (±13) | 63 (±9.0) | 71 (±8.7) | 0.091 |
| Median [Q1, Q3] | 64 [55, 69] | 64 [51, 70] | 62 [55, 68] | 65 [65, 79] | |
| Age at initial evaluation (Years) | |||||
| Mean (SD) | 65 (±11) | 64 (±12) | 65 (±9.2) | 72 (±9.3) | 0.229 |
| Median [Q1, Q3] | 66 [57, 72] | 67 [54, 73] | 65 [57, 70] | 66 [66, 81] | |
| Duration (Onset-to-Initial eval) | |||||
| Mean (SD) | 2.6 (±3.3) | 3.3 (±4.2) | 2.0 (±1.6) | 1.4 (±0.55) | 0.366* |
| Median [Q1, Q3] | 2.0 [1.0, 3.0] | 2.0 [1.0, 3.0] | 2.0 [1.0, 3.0] | 1.0 [1.0, 2.0] | |
| Gender | |||||
| Man | 101 (96.2%) | 53 (96.4%) | 43 (95.6%) | 5 (100%) | 1 |
| Woman | 4 (3.8%) | 2 (3.6%) | 2 (4.4%) | 0 (0%) | |
| Race | |||||
| Black | 9 (8.6%) | 7 (12.7%) | 1 (2.2%) | 1 (20.0%) | 0.113 |
| Native Indian | 1 (1.0%) | 1 (1.8%) | 0 (0%) | 0 (0%) | |
| White | 95 (90.5%) | 47 (85.5%) | 44 (97.8%) | 4 (80.0%) | |
| Family History | |||||
| Y | 5 (4.8%) | 1 (1.8%) | 4 (8.9%) | 0 (0%) | 0.412 |
| Hypertension | |||||
| Y | 58 (55.2%) | 30 (54.5%) | 25 (55.6%) | 3 (60.0%) | 1 |
| Diabetes mellitus | |||||
| Y | 24 (22.9%) | 14 (25.5%) | 8 (17.8%) | 2 (40.0%) | 0.347 |
| Hyperlipidemia | |||||
| Y | 49 (46.7%) | 23 (41.8%) | 24 (53.3%) | 2 (40.0%) | 0.51 |
| Cervical spondylosis | |||||
| Y | 9 (8.6%) | 7 (12.7%) | 2 (4.4%) | 0 (0%) | 0.396 |
| BMI | |||||
| Mean (SD) | 26 (±6.0) | 27 (±5.8) | 25 (±6.1) | 21 (±3.9) | 0.021* |
| Median [Q1, Q3] | 25 [, ]22 | 27 [, ]24 | 24 [, ]21 | 22 [, ]19 | |
| Smoker | |||||
| Y | 20 (19.0%) | 9 (16.4%) | 11 (24.4%) | 0 (0%) | 0.443 |
| Total co-morbidities | |||||
| 0 | 17 (16.2%) | 12 (21.8%) | 5 (11.1%) | 0 (0%) | 0.335 |
| 1 | 37 (35.2%) | 19 (34.5%) | 15 (33.3%) | 3 (60.0%) | |
| 2 | 26 (24.8%) | 9 (16.4%) | 16 (35.6%) | 1 (20.0%) | |
| 3 | 18 (17.1%) | 9 (16.4%) | 8 (17.8%) | 1 (20.0%) | |
| 4 | 6 (5.7%) | 5 (9.1%) | 1 (2.2%) | 0 (0%) | |
| 5 | 1 (1.0%) | 1 (1.8%) | 0 (0%) | 0 (0%) | |
| Depression | |||||
| Y | 30 (28.6%) | 16 (29.1%) | 13 (28.9%) | 1 (20.0%) | 1 |
| Speech | |||||
| Dysarthric | 52 (49.5%) | 12 (21.8%) | 40 (88.9%) | 0 (0%) | <0.001 |
| Normal | 45 (42.9%) | 41 (74.5%) | 0 (0%) | 4 (80.0%) | |
| Other | 6 (5.7%) | 0 (0%) | 5 (11.1%) | 1 (20.0%) | |
| Swallow | |||||
| Affected | 39 (37.1%) | 3 (5.5%) | 35 (77.8%) | 1 (20.0%) | <0.001 |
| Normal | 65 (61.9%) | 51 (92.7%) | 10 (22.2%) | 4 (80.0%) | |
| Respiration | |||||
| Normal | 73 (69.5%) | 46 (83.6%) | 27 (60.0%) | 0 (0%) | <0.001 |
| SOB | 32 (30.5%) | 9 (16.4%) | 18 (40.0%) | 5 (100%) | |
| MMSE | |||||
| Mean (SD) | 24 (±7.8) | 26 (±4.2) | 21 (±10) | 28 (±1.8) | 0.003* |
| Median [Q1, Q3] | 27 [, ]23 | 28 [, ]25 | 25 [, ]20 | 27 [, ]26 | |
| Upper extremities MRC | |||||
| 0 | 2 (1.9%) | 1 (1.8%) | 1 (2.2%) | 0 (0%) | 0.946 |
| 1 | 3 (2.9%) | 2 (3.6%) | 1 (2.2%) | 0 (0%) | |
| 2 | 10 (9.5%) | 7 (12.7%) | 3 (6.7%) | 0 (0%) | |
| 3 | 28 (26.7%) | 14 (25.5%) | 13 (28.9%) | 1 (20.0%) | |
| 4 | 34 (32.4%) | 15 (27.3%) | 16 (35.6%) | 3 (60.0%) | |
| 5 | 28 (26.7%) | 16 (29.1%) | 11 (24.4%) | 1 (20.0%) | |
| Lower extremities MRC | |||||
| 0 | 5 (4.8%) | 5 (9.1%) | 0 (0%) | 0 (0%) | 0.054 |
| 1 | 6 (5.7%) | 3 (5.5%) | 1 (2.2%) | 2 (40.0%) | |
| 2 | 4 (3.8%) | 3 (5.5%) | 1 (2.2%) | 0 (0%) | |
| 3 | 16 (15.2%) | 10 (18.2%) | 5 (11.1%) | 1 (20.0%) | |
| 4 | 39 (37.1%) | 20 (36.4%) | 18 (40.0%) | 1 (20.0%) | |
| 5 | 35 (33.3%) | 14 (25.5%) | 20 (44.4%) | 1 (20.0%) | |
| Admission ambulation speed (2-MWT, ft/min) | |||||
| Mean (SD) | 200 (±160) | 190 (±160) | 230 (±160) | 92 (±170) | 0.098* |
| Median [Q1, Q3] | 230 [36, 320] | 190 [20, 300] | 260 [85, 390] | 0 [0, 70] | |
| ALSFRS-R | |||||
| Mean (SD) | 31 (±8.3) | 32 (±7.8) | 31 (±8.4) | 26 (±13) | 0.284 |
| Median [Q1, Q3] | 31 [26, 38] | 34 [26, 38] | 30 [25, 38] | 24 [, ]18 | |
| TFIM | |||||
| Mean (SD) | 91 (±25) | 91 (±25) | 92 (±27) | 87 (±27) | 0.857* |
| Median [Q1, Q3] | 99 [71, 110] | 99 [71, 110] | 99 [78, 110] | 71 [68, 110] | |
| FVC | |||||
| Mean (SD) | 73 (±22) | 79 (±20) | 67 (±23) | 52 (±13) | 0.004 |
| Median [Q1, Q3] | 72 [61, 90] | 81 [66, 93] | 69 [56, 82] | 52 [41, 63] | |
| MIP (%) | |||||
| Mean (SD) | 44 (±26) | 58 (±26) | 29 (±13) | 26 (±14) | <0.001* |
| Median [Q1, Q3] | 37 [27, 59] | 56 [38, 76] | 27 [, ]19 | 30 [, ]20 | |
| MEP (%) | |||||
| Mean (SD) | 39 (±28) | 51 (±29) | 26 (±21) | 18 (±9.5) | <0.001* |
| Median [Q1, Q3] | 32 [20, 52] | 42 [32, 71] | 21 [, ]17 | 19 [, ]14 | |
| SNIP (%) – right | |||||
| Mean (SD) | 31 (±22) | 38 (±25) | 23 (±13) | 17 (±15) | 0.028* |
| Median [Q1, Q3] | 26 [17, 40] | 32 [19, 45] | 19 [, ]16 | 16 [9.0, 24] | |
| SNIP (%) – left | |||||
| Mean (SD) | 31 (±23) | 37 (±27) | 23 (±13) | 20 (±16) | 0.137* |
| Median [Q1, Q3] | 23 [, ]18 | 25 [19, 48] | 21 [, ]12 | 26 [, ]14 | |
| * The Kruskal-Wallis test for data did not pass the Shapiro-Wilk normality test (significance threshold 0.05). 2-MWT – 2-minute walk test; ALS – amyotrophic lateral sclerosis; ALSFRS-R – ALS Functional Rating Scale-Revised; BMI – body mass index; FVC – forced vital capacity; MMSE – Mini-Mental State Examination; MRC – medical research council; MEP – mean expiratory pressure; MIP – mean inspiratory pressure; SNIP – sniff nasal inspiratory pressure; TFIM – total function independence measures. | |||||