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Hypermetabolism is a deleterious prognostic factor in patients with amyotrophic lateral sclerosis
Author(s) -
Jésus P.,
Fayemendy P.,
Nicol M.,
Lautrette G.,
Sourisseau H.,
Preux P.M.,
Desport J.C.,
Marin B.,
Couratier P.
Publication year - 2018
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13468
Subject(s) - hypermetabolism , medicine , resting energy expenditure , amyotrophic lateral sclerosis , hazard ratio , proportional hazards model , gastroenterology , disease , confidence interval , energy metabolism
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 (Δ REE ) > 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 (Δ REE: < 10%, 10–20% and >20%), patients with Δ REE > 20% initially had a lower FM (29.7% vs. 32.1% in those with Δ REE ≤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 Δ REE > 20% (−1.4 vs. −1.0 points/month in those with Δ REE ≤10%; P = 0.07). Overall median survival since diagnosis was 18.4 months. Δ REE > 20% tended to increase the risk of dying compared with Δ REE ≤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.