Outcomes of patients with amyotrophic lateral sclerosis admitted to the ICU for acute respiratory failure.
11 affiliations
- 1AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation à orientation neurologique, Paris, France.
- 2Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France.
- 3AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département de neurologie, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.
- 4Department of Neurology, Paris ALS Center, Pitie-Salpetriere University Hospital - Assistance Publique - Hopitaux de Paris, France.
- 5Service de Pneumologie (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié- Salpêtrière, Paris, F-75013, France.
- 6University Paris Cité, Inserm UMR_S1124, 75270, Paris Cedex 06, France.
- 7Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
- 8AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France.
- 9INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.
- 10Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE), Sorbonne Université, Paris, France.
- 11Brain Liver Pitié-Salpêtrière Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition, Paris, France.
Abstract
Background
Data on patients with amyotrophic lateral sclerosis (ALS) admitted to the intensive care unit (ICU) for acute respiratory failure are scarce, and early prognostic markers are lacking.Methods
We conducted a retrospective cohort study of consecutive patients with ALS admitted for acute respiratory failure to two ICUs of a tertiary referral center between 2016 and 2022. The primary outcome was 3-month mortality. Factors associated with 3-month mortality were assessed using multivariable Cox proportional hazards regression. Survival and functional outcomes were evaluated up to 12 months.Results
Among 139 patients [median age 66 (IQR 57-73) years, 61.2% being men], 109 (78.4%) patients presented with hypercapnia and 82 (59.0%) with hypoxemia (defined as PaO₂/FiO₂ ratio < 300) at ICU admission, with frequent overlap between both conditions. Non-invasive ventilation was used in 79.9% of patients, while 13.7% were intubated, and 2.2% underwent tracheostomy. Three-month mortality was 48.2%, increasing to 61.2% and 74.1% at 6 and 12 months respectively. In multivariable analysis, hypoxemia at ICU admission was independently associated with increased 3-month mortality (HR = 2.27, 95% CI: 1.28-4.01; P = 0.005), along with older age (HR=1.03 per year, 95% CI: 1.00-1.06; P = 0.035). Among patients alive at 3 months, a majority (79.2%) were living at home.Conclusion
ICU admission for acute respiratory failure in ALS is associated with substantial short-term mortality, consistent with the poor prognosis inherent to the natural history of the disease. Hypoxemia at admission identifies a subgroup at particularly high risk of death and may help inform early prognostic assessment and shared decision-making. However, patients who survive the acute ICU phase frequently achieve favorable short-term outcomes, with most living at home at 3 months.
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BibTeX
@article{celier2026outcomes,
title = {{Outcomes of patients with amyotrophic lateral sclerosis admitted to the ICU for acute respiratory failure.}},
author = {Adam Celier and Aymeric Lanore and Adele Hesters and Sarah Hussein and Raouf Benchikh and Gaelle Bruneteau and Capucine Morélot-Panzini and Mélodie Parfait and Mathilde Piljan and Loic Le Guennec and Nicolas Weiss and Sophie Demeret and Julien Mayaux and Clemence Marois},
journal = {Annals of intensive care},
year = {2026},
month = oct,
doi = {10.1016/j.aicoj.2026.100183},
url = {https://europepmc.org/article/MED/42926935},
note = {CC BY},
}
RIS
TY - JOUR
TI - Outcomes of patients with amyotrophic lateral sclerosis admitted to the ICU for acute respiratory failure.
AU - Adam Celier
AU - Aymeric Lanore
AU - Adele Hesters
AU - Sarah Hussein
AU - Raouf Benchikh
AU - Gaelle Bruneteau
AU - Capucine Morélot-Panzini
AU - Mélodie Parfait
AU - Mathilde Piljan
AU - Loic Le Guennec
AU - Nicolas Weiss
AU - Sophie Demeret
AU - Julien Mayaux
AU - Clemence Marois
PY - 2026
DA - 2026/10/12
JO - Annals of intensive care
DO - 10.1016/j.aicoj.2026.100183
UR - https://europepmc.org/article/MED/42926935
AB - Background Data on patients with amyotrophic lateral sclerosis (ALS) admitted to the intensive care unit (ICU) for acute respiratory failure are scarce, and early prognostic markers are lacking.Methods We conducted a retrospective cohort study of consecutive patients with ALS admitted for acute respiratory failure to two ICUs of a tertiary referral center between 2016 and 2022. The primary outcome was 3-month mortality. Factors associated with 3-month mortality were assessed using multivariable Cox proportional hazards regression. Survival and functional outcomes were evaluated up to 12 months.Results Among 139 patients [median age 66 (IQR 57-73) years, 61.2% being men], 109 (78.4%) patients presented with hypercapnia and 82 (59.0%) with hypoxemia (defined as PaO₂/FiO₂ ratio < 300) at ICU admission, with frequent overlap between both conditions. Non-invasive ventilation was used in 79.9% of patients, while 13.7% were intubated, and 2.2% underwent tracheostomy. Three-month mortality was 48.2%, increasing to 61.2% and 74.1% at 6 and 12 months respectively. In multivariable analysis, hypoxemia at ICU admission was independently associated with increased 3-month mortality (HR = 2.27, 95% CI: 1.28-4.01; P = 0.005), along with older age (HR=1.03 per year, 95% CI: 1.00-1.06; P = 0.035). Among patients alive at 3 months, a majority (79.2%) were living at home.Conclusion ICU admission for acute respiratory failure in ALS is associated with substantial short-term mortality, consistent with the poor prognosis inherent to the natural history of the disease. Hypoxemia at admission identifies a subgroup at particularly high risk of death and may help inform early prognostic assessment and shared decision-making. However, patients who survive the acute ICU phase frequently achieve favorable short-term outcomes, with most living at home at 3 months.
SN - 2110-5820
ER -