Investigation of the prognostic predictive value of serum lipid profiles in amyotrophic lateral sclerosis: roles of sex and hypermetabolism

Ryutaro Nakamura,Nobuhiro Ogawa,Masaya Sasaki,Isamu Yamakawa,Makoto Urushitani,Shigeki Bamba,Mitsuru Sanada,Akihiro Kitamura,Mika Kurihara

doi:10.1038/s41598-022-05714-w

Ryutaro Nakamura, Nobuhiro Ogawa + Show 7 more

Open Access

https://doi.org/10.1038/s41598-022-05714-w

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Journal: Scientific Reports	Publication Date: Feb 3, 2022
Citations: 17	License type: open-access

Affiliation: Shiga University of Medical Science

Abstract

The prognostic predictive value of lipid profiling in amyotrophic lateral sclerosis (ALS) remains unclear. Here, we aimed to clarify the value of the levels of serum lipids, including high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG), for predicting the prognosis in ALS. This was a single-center retrospective study of 78 patients with ALS. The serum lipid profiles at the first hospital visit after symptom onset were analyzed to determine the correlations of lipids with survival and physical parameters, including nutritional, respiratory, and metabolic conditions. The cutoff level for high HDL was defined as the third quartile, while that of low LDL and TG, as the first quartile. Hypermetabolism was defined as the ratio of resting energy expenditure to lean soft tissue mass ≥ 38 kcal/kg. High HDL was an independent factor for poor prognosis in all patients (hazards ratio [HR]: 9.87, p < 0.001) in the Cox proportional hazard model, including %vital capacity and the monthly decline rate in body mass index and the Revised Amyotrophic Lateral Functional Rating Scale score from symptom onset to diagnosis. Low LDL was a factor for poor prognosis (HR: 6.59, p = 0.017) only in women. Moreover, subgroup analyses with log-rank tests revealed that the prognostic predictive value of high HDL was evident only in the presence of hypermetabolism (p = 0.005). High HDL predicts poor prognosis in all patients, whereas low LDL, only in women. Hypermetabolism and high HDL synergistically augment the negative effect on prognosis.

Highlights

The prognostic predictive value of lipid profiling in amyotrophic lateral sclerosis (ALS) remains unclear
We previously showed that patients with hypermetabolism, defined as the ratio of measured resting energy expenditure to lean soft tissue mass (LSTM) ≥ 38, exhibited significantly shorter survival than patients with normal metabolism only when their body mass index (BMI) was ≥ 19.88
Based on the Cox proportional hazards (PH) models for each sex, which included each lipid profile, ΔALSFRS-R, ΔBMI, and %VC, we found that high high-density lipoprotein cholesterol (HDL) was an independent factor for poor prognosis in both men and women, while low low-density lipoprotein cholesterol (LDL) was a factor only in women (Table 2)

Summary

Introduction

The prognostic predictive value of lipid profiling in amyotrophic lateral sclerosis (ALS) remains unclear. We aimed to clarify the value of the levels of serum lipids, including high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG), for predicting the prognosis in ALS. This was a single-center retrospective study of 78 patients with ALS. We showed that low body fat percentage was associated with poor p rognosis, as reported e lsewhere9 These findings may indicate that the prognostic value of hypermetabolism depends on nutritional status and that lipid metabolism plays a crucial role in determining the prognosis of ALS. Hypermetabolism was found to govern the predictive value of lipids for ALS prognosis, which could reconcile the previous controversies

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