Evaluation of arterial blood gas parameters as prognostic markers in amyotrophic lateral sclerosis

Alarcan, Hugo; Cotet, Camille; Lépine, Nadège; Morel, Julie; Vourc’h, Patrick; Andrés, Christian; Corcia, Philippe; Blasco, Hélène

doi:10.1111/ene.15779

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…Cox univariate analysis of FVC% confirmed that this measure is a strong predictor of survival [28], even when it is considered as ΔFVC%. In the Milan MND cohort, Cox univariate analysis of individual ABG parameters showed a significantly increased HR, and consequentially a shorter survival time in MND patients, when pCO 2 was >45 mmHg,

{HCO}_{3}^{-}

was >24 mmol/L and SBE was >2 mmol/L, confirming the prognostic role of ABG parameters [13, 29]. Interestingly, when considering ABG measurements individually,

{HCO}_{3}^{-}

was found to be the measurement with the earliest changes associated with a worse prognosis, being a negative prognostic factor when it increased above 24 mmHg, which is widely considered within reference limit values.…”

Section: Discussionmentioning

confidence: 88%

Use of the combination of spirometry, arterial blood gas analysis and overnight oximetry to predict the outcomes of patients affected by motor neuron disease: The Milan‐Torin respiratory score (Mi‐To‐RS)

Schito,

Manera,

Russo

et al. 2024

Euro J of Neurology

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Background and purposeThe use of multiple tests, including spirometry, arterial blood gas (ABG) analysis and overnight oximetry (OvOx), is highly recommended to monitor the respiratory function of patients with motor neuron disease (MND). In this study, we propose a composite score to simplify the respiratory management of MND patients and better stratify their prognosis.Materials and MethodsWe screened the clinical charts of 471 non‐ventilated MND patients referred to the Neuro‐rehabilitation Unit of the San Raffaele Scientific Institute of Milan (January 2001–December 2019), collecting spirometric, ABG and OvOx parameters. To evaluate the prognostic role of each measurement, univariate Cox regression for death/tracheostomy was performed, and the variables associated with survival were selected to design a scoring system. Univariate and multivariate Cox regression analyses were then carried out to evaluate the prognostic role of the score. Finally, results were replicated in an independent cohort from the Turin ALS Center.ResultsThe study population included 450 patients. Six measurements were found to be significantly associated with survival and were selected to design a scoring system (maximum score = 8 points). Kaplan–Meier analysis showed significant stratification of survival and time to non‐invasive mechanical ventilation adaptation according to score values, and multivariate analysis confirmed the independent effect of the respiratory score on survival of each cohort.ConclusionForced vital capacity, ABG and OvOx parameters provide complementary information for the respiratory management and prognosis of MND patients and the combination of these parameters into a single score might help neurologists predict prognosis and guide decisions on the timing of the implementation of different diagnostic or therapeutic approaches.

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{HCO}_{3}^{-}

was >24 mmol/L and SBE was >2 mmol/L, confirming the prognostic role of ABG parameters [13, 29]. Interestingly, when considering ABG measurements individually,

{HCO}_{3}^{-}

Section: Discussionmentioning

confidence: 88%

Use of the combination of spirometry, arterial blood gas analysis and overnight oximetry to predict the outcomes of patients affected by motor neuron disease: The Milan‐Torin respiratory score (Mi‐To‐RS)

Schito,

Manera,

Russo

et al. 2024

Euro J of Neurology

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“…In other ALS cohorts, MVV has already been shown to have good correlations with other PFTs, such as FVC, slow vital capacity (SVC), FEV1, SNIP, phrenic nerve amplitude, peak expiratory flow (PEF), and total ALSFRS-R [20]. Recent studies examining independent cohorts [12,13,31] have agreed upon the role of blood carbonate (HCO 3 − ) and base excess (BE) in evaluating early respiratory failure phenomena such as nocturnal hypoventilation, and we also observed a moderate correlation of cMVV with these two ABGs measures.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, consulting the most updated international guidelines on mechanical ventilation [5][6][7][8], there is no international consensus on the best timing for non-invasive ventilation (NIV) adaptation. Thirdly, although forced vital capacity (FVC) is the most commonly used pulmonary function test and outcome measure in clinics, many other respiratory measures, such as nocturnal oximetry [9], capnography [10], sniff nasal inspiratory pressure (SNIP) [11], and arterial blood gas analysis (ABGs) [12,13] have shown high reliability in detecting early signs of respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

Calculated Maximal Volume Ventilation (cMVV) as a Marker of Early Respiratory Failure in Amyotrophic Lateral Sclerosis (ALS)

Manera,

Torrieri,

Moglia

et al. 2024

Brain Sciences

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Respiratory failure assessment is among the most debatable research topics in amyotrophic lateral sclerosis (ALS) clinical research due to the wide heterogeneity of its presentation. Among the different pulmonary function tests (PFTs), maximal voluntary ventilation (MVV) has shown potential utility as a diagnostic and monitoring marker, able to capture early respiratory modification in neuromuscular disorders. In the present study, we explored calculated MVV (cMVV) as a prognostic biomarker in a center-based, retrospective ALS population belonging to the Piemonte and Valle d’Aosta registry for ALS (PARALS). A Spearman’s correlation analysis with clinical data and PFTs showed a good correlation of cMVV with forced vital capacity (FVC) and a moderate correlation with some other features such as bulbar involvement, ALSFRS-R total score, blood oxygen (pO2), carbonate (HCO3−), and base excess (BE), measured with arterial blood gas analysis. Both the Cox proportional hazard models for survival and the time to non-invasive ventilation (NIV) measurement highlighted that cMVV at diagnosis (considering cMVV(40) ≥ 80) is able to stratify patients across different risk levels for death/tracheostomy and NIV indication, especially considering patients with FVC% ≥ 80. In conclusion, cMVV is a useful marker of early respiratory failure in ALS, and is easily derivable from standard PFTs, especially in asymptomatic ALS patients with normal FVC measures.

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“…Given that respiratory failure is the main cause of mortality in ALS, measurements of respiratory functionality are integrated not only in clinical practice, but also in ALS prognostic models [ 12 , 242 ]. However, more recent studies have highlighted that not only slow (SVC) or forced vital capacity (FCV) [ 243 ] may be a useful prognostic marker but that other parameters such as arterial blood gas parameters and base excess may independently predict shorter survival in ALS [ 244 , 245 ]. Within this context, a recent neurophysiological study pointed out that Diaphragmatic CMAP amplitude from phrenic nerve stimulation may also be able to predict functional decline in ALS [ 246 ].…”

Section: Prognosismentioning

confidence: 99%

Update on recent advances in amyotrophic lateral sclerosis

Riva,

Domi,

Pozzi

et al. 2024

J Neurol

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In the last few years, our understanding of disease molecular mechanisms underpinning ALS has advanced greatly, allowing the first steps in translating into clinical practice novel research findings, including gene therapy approaches. Similarly, the recent advent of assistive technologies has greatly improved the possibility of a more personalized approach to supportive and symptomatic care, in the context of an increasingly complex multidisciplinary line of actions, which remains the cornerstone of ALS management. Against this rapidly growing background, here we provide an comprehensive update on the most recent studies that have contributed towards our understanding of ALS pathogenesis, the latest results from clinical trials as well as the future directions for improving the clinical management of ALS patients.

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Evaluation of arterial blood gas parameters as prognostic markers in amyotrophic lateral sclerosis

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 3 publications

References 17 publications

Use of the combination of spirometry, arterial blood gas analysis and overnight oximetry to predict the outcomes of patients affected by motor neuron disease: The Milan‐Torin respiratory score (Mi‐To‐RS)

Use of the combination of spirometry, arterial blood gas analysis and overnight oximetry to predict the outcomes of patients affected by motor neuron disease: The Milan‐Torin respiratory score (Mi‐To‐RS)

Calculated Maximal Volume Ventilation (cMVV) as a Marker of Early Respiratory Failure in Amyotrophic Lateral Sclerosis (ALS)

Update on recent advances in amyotrophic lateral sclerosis

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