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Enteral feeding is associated with longer survival in the advanced stages of prion disease

To report the frequency, complications, survival and motivations for enteral feeding in UK patients with prion diseases. We analysed data from an ongoing prospective observational cohort study of UK patients with prion diseases (n = 635). Gastrostomy-treated cases were matched by age, gender, diseas...

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Autores principales: McNiven, Kirsty, Nihat, Akin, Mok, Tze How, Tesfamichael, Selam, O’Donnell, Veronica, Rudge, Peter, Collinge, John, Mead, Simon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425295/
https://www.ncbi.nlm.nih.gov/pubmed/32954259
http://dx.doi.org/10.1093/braincomms/fcz012
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author McNiven, Kirsty
Nihat, Akin
Mok, Tze How
Tesfamichael, Selam
O’Donnell, Veronica
Rudge, Peter
Collinge, John
Mead, Simon
author_facet McNiven, Kirsty
Nihat, Akin
Mok, Tze How
Tesfamichael, Selam
O’Donnell, Veronica
Rudge, Peter
Collinge, John
Mead, Simon
author_sort McNiven, Kirsty
collection PubMed
description To report the frequency, complications, survival and motivations for enteral feeding in UK patients with prion diseases. We analysed data from an ongoing prospective observational cohort study of UK patients with prion diseases (n = 635). Gastrostomy-treated cases were matched by age, gender, disease aetiology, severity, duration and a genetic predictor of survival (ratio 1:3.1). The main outcome was survival (unadjusted log-rank test); secondary outcomes were future functional impairments, complications and retrospective carer interviews to determine qualitative benefits and motivations. Enteral feeding is uncommon in UK patients with prion diseases (n = 26/635; 4.1%), but more frequent in acquired (7/41, 17.1%) and inherited (7/128, 5.5%) compared with sporadic disease (12/466, 2.6%; P = 3 × 10(−5) chi-squared), and used mostly at advanced stages. Enteral feeding was complicated by infection and the need for reinsertions, but associated with markedly longer survival at advanced neurodisability (median 287 days, range 41–3877 versus 17 days, range 0–2356; log-rank test in three aetiologies each P < 0.01). Interviews revealed different motivations for enteral feeding, including perceived quality of life benefits. We provide Class II evidence that enteral feeding prolongs the akinetic-mute phase of all aetiological types of prion disease. These data may help support decision making in palliative care. Enteral feeding is an important potential confounder in prion disease clinical trials that use survival as an endpoint.
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spelling pubmed-74252952020-09-17 Enteral feeding is associated with longer survival in the advanced stages of prion disease McNiven, Kirsty Nihat, Akin Mok, Tze How Tesfamichael, Selam O’Donnell, Veronica Rudge, Peter Collinge, John Mead, Simon Brain Commun Original Article To report the frequency, complications, survival and motivations for enteral feeding in UK patients with prion diseases. We analysed data from an ongoing prospective observational cohort study of UK patients with prion diseases (n = 635). Gastrostomy-treated cases were matched by age, gender, disease aetiology, severity, duration and a genetic predictor of survival (ratio 1:3.1). The main outcome was survival (unadjusted log-rank test); secondary outcomes were future functional impairments, complications and retrospective carer interviews to determine qualitative benefits and motivations. Enteral feeding is uncommon in UK patients with prion diseases (n = 26/635; 4.1%), but more frequent in acquired (7/41, 17.1%) and inherited (7/128, 5.5%) compared with sporadic disease (12/466, 2.6%; P = 3 × 10(−5) chi-squared), and used mostly at advanced stages. Enteral feeding was complicated by infection and the need for reinsertions, but associated with markedly longer survival at advanced neurodisability (median 287 days, range 41–3877 versus 17 days, range 0–2356; log-rank test in three aetiologies each P < 0.01). Interviews revealed different motivations for enteral feeding, including perceived quality of life benefits. We provide Class II evidence that enteral feeding prolongs the akinetic-mute phase of all aetiological types of prion disease. These data may help support decision making in palliative care. Enteral feeding is an important potential confounder in prion disease clinical trials that use survival as an endpoint. Oxford University Press 2019-09-10 /pmc/articles/PMC7425295/ /pubmed/32954259 http://dx.doi.org/10.1093/braincomms/fcz012 Text en © The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
McNiven, Kirsty
Nihat, Akin
Mok, Tze How
Tesfamichael, Selam
O’Donnell, Veronica
Rudge, Peter
Collinge, John
Mead, Simon
Enteral feeding is associated with longer survival in the advanced stages of prion disease
title Enteral feeding is associated with longer survival in the advanced stages of prion disease
title_full Enteral feeding is associated with longer survival in the advanced stages of prion disease
title_fullStr Enteral feeding is associated with longer survival in the advanced stages of prion disease
title_full_unstemmed Enteral feeding is associated with longer survival in the advanced stages of prion disease
title_short Enteral feeding is associated with longer survival in the advanced stages of prion disease
title_sort enteral feeding is associated with longer survival in the advanced stages of prion disease
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425295/
https://www.ncbi.nlm.nih.gov/pubmed/32954259
http://dx.doi.org/10.1093/braincomms/fcz012
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