A Predictive Model and Survival Analysis for Tube Feeding in ALS Patients: A Prospective Cohort Study in a Chinese ALS Clinic

Table 1

The clinical characteristics of ALS patients stratified by the tube feeding at diagnosis or during follow-up.

Variables	Tube feeding		Total ()	Statistics	value
	No ()	Yes ()
	(%) or mean (SD) or median (IQR)	(%) or mean (SD) or median (IQR)	(%) or mean (SD) or median (IQR)
At baseline
Sex					0.592
Male	115 (62.5)	19 (55.9)	134 (61.5)
Female	69 (37.5%)	15 (44.1%)	84 (38.5%)
Familiar ALS	22 (12.0)	3 (8.8)	25 (11.5)	Fisher’s exact test	0.774
Age of onset (y)	53.21 (12.42)	58.09 (12.37)	53.97 (12.51)	-test	0.036
Death	40 (21.7)	14 (41.2)	54 (24.8)		0.028
Site of disease onset					<0.001
Bulbar	24 (13.0)	16 (47.1)	40 (18.3)
Spinal	160 (87.0%)	18 (52.9%)	178 (81.7%)
Time to diagnose (m)	10.50 (6.00, 18.00)	9.00 (6.25, 12.00)	10.00 (6.00, 16.00)	Mann–Whitney test	0.257
Weight loss (%)	81 (44.0)	22 (64.7)	103 (47.2)		0.042
Weight loss (kg)	0.00 (0.00, 5.00)	5.00 (0.00, 10.00)	0.00 (0.00, 5.00)	Mann–Whitney test	0.001
BMI at baseline (kg/m^2)	23.00 (21.00, 25.00)	22.00 (18.00, 24.00)	23.00 (20.00, 25.00)	Mann–Whitney test	0.029
NBRI				Fisher’s exact test	<0.001
1	58 (31.5)	2 (5.9)	60 (27.5)
2	57 (31.0)	5 (14.7)	62 (28.4)
3	40 (21.7)	9 (26.5)	49 (22.5)
4	22 (12.0)	18 (52.9)	40 (18.3)
Bulbar involvement	78 (42.4)	32 (94.1)	110 (50.5)	Fisher’s exact test	<0.001
Upper limb involvement	124 (67.4)	28 (2.4)	152 (69.7)	Fisher’s exact test	0.104
Lower limb involvement	129 (70.1)	30 (88.2)	159 (72.9)	Fisher’s exact test	0.035
Respiratory involvement	49 (26.6)	21 (61.8)	70 (32.1)		<0.001
ALSFRS-R score	40.00 (36.00, 44.00)	31.00 (18.00, 36.75)	39.00 (35.00, 43.00)	Mann–Whitney test	<0.001
Bulbar score	12.00 (10.00, 12.00)	5.50 (2.00, 10.00)	11.00 (9.00, 12.00)	Mann–Whitney test	<0.001
Fine motor score	9.00 (7.00, 11.00)	5.00 (2.00, 8.75)	9.00 (6.00, 11.00)	Mann–Whitney test	<0.001
Gross motor score	9.00 (7.00, 11.00)	7.00 (3.00, 9.00)	9.00 (6.00, 11.00)	Mann–Whitney test	0.004
Respiratory score	12.00 (11.00, 12.00)	11.00 (9.00, 12.00)	12.00 (11.00, 12.00)	Mann–Whitney test	<0.001
ALSFRS-R slope	0.42 (0.22, 0.91)	0.84 (0.56, 1.37)	0.48 (0.25, 0.98)	Mann–Whitney test	<0.001
Ischemic stroke	1 (0.5)	3 (8.8)	4 (1.8)	Fisher’s exact test	0.013
During follow-up
NIV routine users	37 (20.1)	20 (58.8)	57 (26.1)		<0.001
Dyspnea	75 (40.8)	26 (76.5)	101 (46.3)		<0.001
Dysphagia	80 (43.5)	24 (70.6)	104 (47.7)		0.007
Past history
Hyperlipidemia^a	21 (11.4)	4 (11.8)	25 (11.5)	Fisher’s exact test	1
Hypertension^a	56 (30.4)	11 (32.4)	67 (30.7)	Fisher’s exact test	0.841
Diabetes^a	13 (7.1)	1 (2.9)	14 (6.4)	Fisher’s exact test	0.702
Drinking^a	55 (29.9)	12 (35.3)	67 (30.7)		0.671
Smoking^a	72 (39.1)	13 (38.2)	85 (39.0)		1
Depression^a	4 (2.2)	0 (0.0)	4 (1.8)	Fisher’s exact test	1
Anxiety^a	3 (1.6)	1 (2.9)	4 (1.8)	Fisher’s exact test	0.495
Malignancy^a	6 (3.3)	1 (2.9)	7 (3.2)	Fisher’s exact test	1
Allergy^a	15 (8.2)	2 (5.9)	17 (7.8)	Fisher’s exact test	1
Exposure of toxic substances^a	31 (16.8)	6 (17.6)	37 (17.0)		1
Trauma^a	57 (31.0)	9 (26.5)	66 (30.3)		0.747
Surgical history^a	69 (37.5)	12 (36.4)	81 (37.3)		1

Patients with bulbar onset, older onset age, early body weight loss, low BMI at baseline, history of ischemic stroke, and high ALSFRS-R slope tended to have tube feeding. In addition, the patient with a low ALSFRS-R score and subregion score or at baseline was more likely to have tube feeding. The percentage of ALS patients with bulbar, lower limb, or respiratory involved at baseline was higher in the tube feeding group. During the follow-up, NIV users and patients with dyspnea or dysphagia were more likely to have tube feeding. The mortality rate of patients with tube feeding was higher than those without tube feeding. ALS patients with past history at diagnosis (such as hyperlipidemia, hypertension, diabetes, drinking, smoking, depression, anxiety, malignancy, allergy, exposure of toxic substances, trauma, and surgical history) had no difference in tube feeding. Familiar ALS patients did not have the higher tube feeding rate. Note: ALSFRS-R: Amyotrophic Lateral Sclerosis Functional Rating Scale revised; BMI: body mass index; a: at baseline; y: year; m: month; kg: kilogram; NIV: noninvasive ventilation; NBRI: body regions involved; : number; : probability. In bold: value < 0.05.