Survival Analysis of Amyotrophic Lateral Sclerosis: An Ambispective Cohort Study in a Thai Tertiary Care Center

Chinakit  Idsaraphorn; Preeda  Arayawichanon; Jukrapope  Jitpimolmard; Pitchaya  Wiratchotisatian; Nantaporn Jitpimolmard

Authors

Chinakit Idsaraphorn Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Thailand https://orcid.org/0009-0006-1999-5310
Preeda Arayawichanon Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Thailand https://orcid.org/0000-0002-3729-6410
Jukrapope Jitpimolmard The National Phenome Institute, Office of the President, Khon Kaen University, Khon Kaen, Thailand https://orcid.org/0009-0001-9170-426X
Pitchaya Wiratchotisatian Department of Statistic, Faculty of Science, Khon Kaen University, Thailand https://orcid.org/0000-0002-7482-1229
Nantaporn Jitpimolmard Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Thailand https://orcid.org/0000-0002-2210-4260

Keywords:

amyotrophic lateral sclerosis, motor neuron disease, survival analysis, prognosis, tertiary-care hospital

Abstract

Objectives: To determine the median survival time and identify independent prognostic factors for mortality in amyotrophic lateral sclerosis (ALS) patients at a tertiary-care hospital in Thailand.

Study design: Ambispective cohort study

Setting: Outpatient rehabilitation department of a tertiary care hospital in Thailand

participant: Forty-four patients diagnosed with ALS according to the Awaji criteria

Methods: We analyzed clinical data from patients treated between January 2012 and July 2022. Survival time curves were generated using the Kaplan-Meier method. To identify predictors of mortality, a full multivariable Cox proportional hazards model was first constructed, followed by a parsimonious model retaining variables with p < 0.20.

Results: The cohort had a male-to-female ratio of 1.3:1 and a mean age at onset of the study of 56.6 years. The median overall survival time from symptom onset to death was 37.0 months (95%CI: 31.0-44.0). In the final multivariable Cox model (C-index = 0.80), a longer interval from symptom onset to diagnosis was the only statistically significant independent predictor of improved survival time (HR = 0.11, 95%CI: 0.01-0.90, p = 0.04). While the presence of major complications (HR = 3.05, p = 0.06), hypertension (HR = 2.98, p = 0.08), and male sex (HR = 2.24, p = 0.17) showed strong clinical trends toward increased mortality, none reached statistical significance in the refined model. Riluzole use was not associated with a survival benefit in this cohort (HR = 0.77, p = 0.74).

Conclusions: The median survival time of Thai ALS patients was 37 months. The time from symptom onset to diagnosis is a key indicator of survival time, likely reflecting the underlying biological speed of the disease. While complications and comorbidities such as hypertension influence the clinical course, larger multicenter studies are needed to validate these prognostic markers in the Southeast Asian population.

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