Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK.
Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK.
Eur J Neurol. 2021 Aug;28(8):2756-2765. doi: 10.1111/ene.14940. Epub 2021 Jun 15.
This study was undertaken to determine the prevalence of multimorbidity in people with motor neuron disease (MND) and to identify whether specific patterns of multimorbidity impact survival beyond age alone.
We performed a retrospective analysis of the Scottish national MND register from 1 January 2015 to 29 October 2019. People with amyotrophic lateral sclerosis, primary lateral sclerosis, progressive muscular atrophy, or progressive bulbar palsy were included. We fitted latent class regression models incorporating comorbidities (class indicators), age, sex, and bulbar onset (covariates), and survival (distal outcome) with multimorbidity as a hypothesised latent variable. We also investigated the association between the Charlson Comorbidity Index and survival in Cox regression and compared its discrimination and calibration to age alone.
A total of 937 people with MND were identified (median age = 67 years, 60.2% male); 64.8% (n = 515) had two or more comorbidities. We identified a subpopulation with high prevalence of cardiovascular disease, but when accounting for the relationship between age and individual comorbidities, there was no difference in survival. Both Charlson Comorbidity Index (hazard ratio [HR] per unit increase = 1.11, 95% confidence interval [CI] = 1.07-1.15, p < 0.0001) and age (HR per year increase = 1.04, 95% CI = 1.03-1.05, p < 0.0001) were significantly associated with survival, but discrimination was higher for age compared to Charlson Comorbidity Index (C-index = 0.63 vs. 0.59).
Multimorbidity is common in MND, necessitating holistic interdisciplinary management, but age is the dominant predictor of prognosis in people with MND. Excluding people with MND and multimorbidity from trial participation may do little to homogenise the cohort in terms of survival potential and could harm generalisability.
本研究旨在确定运动神经元病（MND）患者的共病患病率，并确定特定的共病模式是否会对生存产生影响，而不仅仅是年龄因素。
我们对 2015 年 1 月 1 日至 2019 年 10 月 29 日期间苏格兰国家 MND 登记处进行了回顾性分析。纳入了肌萎缩侧索硬化症、原发性侧索硬化症、进行性肌肉萎缩症或进行性球麻痹患者。我们使用潜在类别回归模型，纳入了共病（类别指标）、年龄、性别和球部发病（协变量），以及生存（远端结局），将共病作为假设的潜在变量。我们还在 Cox 回归中调查了 Charlson 共病指数与生存的相关性，并比较了其对年龄的单独区分度和校准度。
共纳入 937 例 MND 患者（中位年龄=67 岁，60.2%为男性）；64.8%（n=515）有两种或以上的共病。我们发现一个心血管疾病患病率较高的亚群，但在考虑年龄与个体共病之间的关系后，生存无差异。Charlson 共病指数（每增加一个单位的风险比[HR]为 1.11，95%置信区间[CI]为 1.07-1.15，p<0.0001）和年龄（每年增加的 HR 为 1.04，95%CI 为 1.03-1.05，p<0.0001）与生存显著相关，但年龄的区分度高于 Charlson 共病指数（C 指数为 0.63 比 0.59）。
MND 患者共病很常见，需要进行整体的跨学科管理，但年龄是 MND 患者预后的主要预测因素。将 MND 患者和共病患者排除在试验之外，对生存潜力的影响可能很小，并且可能会损害普遍性。
