Objective To determine whether lipids and apolipoproteins predict prognosis of patients with amyotrophic lateral sclerosis in a cohort study of 99 amyotrophic lateral sclerosis patients who were diagnosed during 2015-2018 and followed until October 31, 2018, at the Neurology Clinic in Karolinska University Hospital in Stockholm, Sweden.

Methods Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, apolipoprotein A-I, apolipoprotein B, and lipid ratios were measured at the time of amyotrophic lateral sclerosis diagnosis or shortly thereafter. Death after amyotrophic lateral sclerosis diagnosis was used as the main outcome. Cox model was used to estimate hazard ratios with 95% confidence intervals of death after amyotrophic lateral sclerosis diagnosis, after controlling for sex, age at diagnosis, site of symptoms onset, diagnostic delay, body mass index, Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised, and progression rate.

Results One-standard deviation increase of total cholesterol (hazard ratio, 0.60; 95% confidence interval, 0.41-0.89; P=0.01), low-density lipoprotein cholesterol (hazard ratio, 0.64; 95% confidence interval, 0.44-0.92; P=0.02), low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (hazard ratio, 0.65; 95% confidence interval, 0.46-0.92; P=0.02), apolipoprotein B (hazard ratio, 0.62; 95% confidence interval, 0.44-0.88; P=0.01), or apolipoprotein B/apolipoprotein A-I ratio (hazard ratio, 0.61; 95% confidence interval, 0.43-0.86; P<0.01) were all associated with a lower risk of death after amyotrophic lateral sclerosis diagnosis. A dose-response relationship was also noted when analyzing these biomarkers as categorical variables.

Conclusions Lipids and apolipoproteins are important prognostic indicators for amyotrophic lateral sclerosis and should be monitored at the diagnosis of amyotrophic lateral sclerosis.