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Publications

Journal Article Ahead of print

PubMed: 42895434 DOI: 10.1080/21678421.2026.2742815

Factors associated with post-tracheostomy survival in Amyotrophic Lateral Sclerosis.

Amyotroph Lateral Scler Frontotemporal Degener

Authors: Alessandra Maccabeo, Sara Cabras, Stefano Callegaro, Maria Ida Pateri, Francesca Pili, Antonio Canosa, Umberto Manera, Francesca Palumbo, Enrico Matteoni, Giorgio Pellegrino, Emilio Minerva, Alessandro Ciravegna, Giulia Gianferrari, Monica Puligheddu, Cristina Moglia, Fabiola De Marchi, Letizia Mazzini, Jessica Mandrioli, Giuseppe Borghero, Adriano ChiĆ², Andrea Calvo, Rosario Vasta

Affiliations

  • Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.
  • International School of Advanced Studies, University of Camerino, Camerino, Italy.
  • Neurology Unit, University Hospital of Cagliari, Cagliari, Italy.
  • Neurology Unit 1U, "City of Health and Science" University Hospital, Turin, Italy.
  • Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy.
  • Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
  • Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
  • ALS Center, "Maggiore della CaritĆ " University Hospital, University of Piemonte Orientale, Novara, Italy, and.
  • Neurology Unit Department of Neurosciences Azienda Ospedaliero Universitaria di Modena, Modena, Italy.

Abstract

OBJECTIVE

To identify demographic and clinical factors associated with post-tracheostomy survival using three well-characterized cohorts of patients with Amyotrophic Lateral Sclerosis (ALS).

METHODS

ALS patients from the Piemonte and Valle d'Aosta ALS Register (PARALS) diagnosed between 1995-2019 interval who underwent tracheostomy were included. A multivariable Cox proportional hazards model was used to identify factors associated with post-tracheostomy survival. Significant findings were tested in two independent cohorts, the Emilia-Romagna Region ALS Register (ERRALS) and an incident ALS cohort from South Sardinia.

RESULTS

A total of 449 patients from PARALS underwent tracheostomy during the study period, with a median post-tracheostomy survival of 16.3ā€‰months (IQR 4.0-45.0). Younger age at tracheostomy was associated with longer survival (HR 1.03 per one-year increase, 95%CI1.01-1.05, pā€‰=ā€‰0.001), as being married/cohabiting (HR 0.78, 95%CI0.61-0.98, pā€‰=ā€‰0.033), a longer diagnosis-to-tracheostomy interval (HR 0.84 per one-year increase, 95%CI0.79-0.90, pā€‰<ā€‰0.001) and a lower ALS Functional Rating Scale slope from onset to tracheostomy (HR 1.13 per one-unit increase, 95%CI1.03-1.25, pā€‰=ā€‰0.012). These associations were replicated in the independent cohorts, when data were available. Additionally, discharge to nursing homes was associated with poorer survival in the Sardinian cohort (HR 4.23, 95%CI2.49-7.19; pā€‰<ā€‰0.001), whereas a more recent year of tracheostomy was associated with longer survival in the ERRALS cohort (HR 0.95, 95%CI0.90-0.99; pā€‰=ā€‰0.019).

DISCUSSION

We identified multiple factors associated with post-tracheostomy survival in ALS patients, encompassing clinical and demographic characteristics at tracheostomy as well as local factors influencing peri- and post-operative care. These findings may support decision-making and clinician-patient communication in the advanced stages of ALS.

MeSH

Sclerosis, Tracheostomy, Amyotrophic Lateral Sclerosis, Demography, Prognosis