Cardiovascular diseases may play a negative role in the prognosis of ALS

Background : Only a few studies considered the role of comorbidities on ALS prognosis and provided conflicting results. Methods : our multicenter, retrospective study included patients diagnosed from 1/1/2009 to 31/12/2013 in 13 Referral Centers for ALS located in 10 Italian Regions. Caring neurologists collected a detailed phenotypic profile and follow-up data until death into an electronic database. Comorbidities at diagnosis were recorded by main categories and single medical diagnosis, with the aim of investigating their role on ALS prognosis. Results : 2354 incident cases were collected, with a median survival time from onset to death/tracheostomy of 43 months. According to univariate analysis, together with well known clinical prognostic factors (age at onset, diagnostic delay, site of onset, phenotype, Revised El Escorial Criteria (R-EEC) and BMI at diagnosis), the presence of dementia, hypertension, heart diseases, chronic obstructive pulmonary disease, haematological and psychiatric diseases were associated with worse survival. In multivariate analysis age at onset, diagnostic delay, phenotypes, BMI at diagnosis, R-EEC, dementia, hypertension, heart diseases (atrial fibrillation and heart failure), and haematological diseases (disorders of thrombosis and haemostasis) were independent prognostic factors of survival in ALS. Conclusions : our large, multicenter study demonstrated that, together with the known clinical prognostic factors on ALS survival, hypertension and heart diseases (i.e. atrial fibrillation and heart failure) as well as haematological diseases are independently associated to a shorter