Abstract
Background: Motor neuron disease (MND) is a progressive neurodegenerative condition, that impacts swallowing and breathing. Enteral feeding via gastrostomy is a key intervention to prevent significant weight loss, improve quality of life and increase survival. This is the first study conducted in Australia exploring demographic, clinical and nutritional factors associated with poor prognosis and reduced survival time in MND patients with gastrostomy.
Methods: The retrospective study analysed 94 MND patients (n=58 bulbar-onset and n=36 limb-onset) who underwent gastrostomy between 2015-2021 at a major tertiary hospital in Western Australia. The primary outcome was the survival time from gastrostomy insertion to death. The poor prognosis group was defined as patients who passed away within 60 days post gastrostomy. Multiple logistic regression was conducted to identify demographic, clinical, and nutritional factors associated with poor prognosis within 60 days post gastrostomy. Univariate and multiple Cox regression was used to identify factors associated with survival time.
Results: The median survival time from gastrostomy to death was 357 days (± 29.3, 95% CI:299.5, 414.5). Kaplan–Meier method and log-rank test revealed lower body mass index < 18.5 kg/m2 at the time of gastrostomy insertion (p=0.023) had shorter survival. Cox proportional hazards model with multivariate adjustment revealed that older age (p=0.004), and greater weight loss from diagnosis to gastrostomy (p=0.002) were associated with shorter survival time post gastrostomy. Limb onset (p=0.032), NIV use not being required (p=0.002) and daily NIV use when required and tolerated (p=0.007) were associated with longer survival. Reduced lung function (forced vital capacity ≤50%) and ≥20% weight loss from diagnosis to gastrostomy were predictors of the poor prognosis within 60 days post gastrostomy.
Conclusions: Preventing weight loss from diagnosis and encouraging NIV use when needed are modifiable factors that may prolong the survival of MND patients with gastrostomy.