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Silva GAD, Oliveira LCD, Wiegert EVM, Calixto-Lima L, Cunha GDC, Peres WAF. Prognostic risk stratification using C-reactive protein, albumin, and associated inflammatory biomarkers in patients with advanced cancer in palliative care. Curr Probl Cancer 2024; 51:101115. [PMID: 38943779 DOI: 10.1016/j.currproblcancer.2024.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/10/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE To evaluate the prognostic value of C-reactive protein (CRP), albumin, CRP/albumin ratio (CAR), and modified Glasgow Prognostic Score (mGPS) at different thresholds in patients with advanced cancer in palliative care. METHODS Prospective cohort study with patients evaluated at a palliative care unit in Brazil between July 2016 and March 2020. We included patients ≥ 20 years old, both sexes, able to provide the necessary information or accompanied by someone able to do so, and Karnofsky Performance Status ≥ 30 %. The exclusion criteria were the absence of laboratory data and previous diagnosis of autoimmune and infectious diseases. The thresholds analyzed were: CRP < 5 vs. 5-10 vs. > 10 mg/L, albumin < 2.4 vs. 2.4-2.9 vs. 3.0-3.5 vs. > 3.5 g/dL; CAR <1.2 vs. 1.2-2.0 vs. > 2.0, and mGPS equal to 0 vs. 1 vs. 2. Kaplan-Meier curves and Cox regression models (with hazard ratios [HR] and 95% confidence interval [CI]) were used to evaluate prognostic value, and the concordance statistic (C-statistic) was used to evaluate the predictive accuracy of these thresholds to predict death within 90 days. RESULTS A total of 1,877 patients were included. Median overall survival was 51 (19;124) days and decreased in line with the deterioration of the inflammatory biomarkers. According to the Cox regression models, HR increased as the thresholds worsened (CRP: 1.74 [95% CI, 1.50-2.02] to 2.30 [95% CI, 2.00-2.64]; albumin: 1.77 [95% CI, 1.52-2.07] to 2.60 [95% CI, 2.15-3.14]; CAR: 1.47 [95% CI, 1.21-1.77] to 2.35 [95% CI, 2.05-2.69]; mGPS: 1.78 [95% CI, 1.40-2.23] to 1.89 [95% CI, 1.65-2.15]). All the inflammatory biomarkers evaluated showed discriminatory accuracy for predicting death (C-statistic >0.70), with CAR as the best parameter (C-statistic: 0.80). CONCLUSION Our results suggest that CRP, albumin, CAR, and mGPS can be used as clinically meaningful biomarkers to stratify patients with advanced cancer in palliative care according to the severity of these indicators.
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Affiliation(s)
- Geisiane Alves da Silva
- Department of Nutrition and Dietetics, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Wilza Arantes Ferreira Peres
- Department of Nutrition and Dietetics, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Zhang N, Liu Y, Yang C, Li X. Review of the Predictive Value of Biomarkers in Sepsis Mortality. Emerg Med Int 2024; 2024:2715606. [PMID: 38938850 PMCID: PMC11208822 DOI: 10.1155/2024/2715606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/26/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024] Open
Abstract
Sepsis is a leading cause of mortality among severely ill individuals, primarily due to its potential to induce fatal organ dysfunction. For clinicians, it is vital to have appropriate indicators, including the physiological status and personal experiences of patients with sepsis, to monitor the condition and assess prognosis. This approach aids in preventing the worsening of the illness and reduces mortality. Recent guidelines for sepsis focus on improving patient outcomes through early detection and timely treatment. Nonetheless, identifying severe cases and predicting their prognoses remain challenging. In recent years, there has been considerable interest in utilising the C-reactive protein (CRP)/albumin ratio (CAR) to evaluate the condition and forecast the prognosis of patients with sepsis. This research concentrates on the significance of CAR in the pathological process of sepsis, its association with prognosis, and the latest developments in employing procalcitonin, lactic acid, CRP, and other potential biomarkers. The CAR, with its predictive value for sepsis prognosis and mortality, is increasingly used as a clinical biochemical marker in diagnosing and monitoring patients with sepsis.
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Affiliation(s)
- Nai Zhang
- Department of Emergency, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang 330003, China
| | - Yujuan Liu
- Department of Emergency, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang 330003, China
| | - Chuang Yang
- Department of Emergency, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang 330003, China
| | - Xinai Li
- Department of Respiratory Medicine, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang 330003, China
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Banerjee S, Khubchandani J, Tisinger S, Batra K, Greenway M. Mortality risk among adult americans living with cancer and elevated CRP. Cancer Epidemiol 2024; 90:102569. [PMID: 38599039 DOI: 10.1016/j.canep.2024.102569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
The role of C Reactive Protein (CRP) in predicting long-term outcomes among people living with cancer has not been well explored. We aimed to assess the role of elevated CRP in predicting all-cause mortality among a community-based sample of adult Americans living with cancer. The National Health and Nutrition Examination Survey, 1999-2010 was linked with mortality files up to December 2019 from the National Death Index. Sociodemographic and health-related variables of 30,711 participants (mean age=46.5 years) were analyzed to compute adjusted hazard ratios (HR) for all-cause mortality. The risk of mortality, in unadjusted analysis, was significantly higher among those with cancer compared to those without cancer 3.53 (95% CI= 3.13-3.98, p < 0.001). In adjusted analysis, when stratified by CRP levels (elevated=cutoff point at ≥2 mg/dL), among individuals with elevated CRP but no cancer history, the risk of mortality was significantly higher (HR=1.67, 95% CI=1.24-2.25) compared to those without cancer or elevated CRP. Among individuals with cancer but without elevated CRP as well, the risk of mortality was 20% higher compared to their counterparts. The highest risk of mortality was observed among those with both cancer and elevated CRP (HR=2.10, 95% CI=1.11-4.33). Age and income were significant predictors of these relationships. Among people living with cancer, CRP may serve as a marker for mortality and future studies should explore the pathways by which the risk of mortality may increase due to variation of CRP in cancer patients.
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Affiliation(s)
- Srikanta Banerjee
- College of Health Sciences, Walden University, Minneapolis, MN 55401, United States
| | - Jagdish Khubchandani
- College of Health, Education, and Social Transformation, New Mexico State University, Las Cruces, NM 88003, United States.
| | - Shalika Tisinger
- College of Health Sciences, Walden University, Minneapolis, MN 55401, United States
| | - Kavita Batra
- Department of Medical Education, University of Nevada, Las Vegas, Las Vegas, NV 89102, United States
| | - Maribeth Greenway
- Department of Infection Prevention and Control, Carilion Clinic, Roanoke, VA 24014, United States
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Taş-Aygar G, Ataş H, Gönül M, Kartal SP. Importance of the C-Reactive Protein to Albumin Ratio in the Diagnosis and Prognosis of Mycosis Fungoides. Dermatol Pract Concept 2024; 14:dpc.1402a97. [PMID: 38810087 PMCID: PMC11135996 DOI: 10.5826/dpc.1402a97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION The C-reactive protein to albumin ratio (CAR) lately has demonstrated as a prognostic factor and an indicator of disease activity, severity and prognosis in solid organ malignancies and inflammatory diseases. However, the effects of CAR have not been investigated in mycosis fungoides (MF) patients yet. OBJECTIVES This study aimed to determine the potential role of CAR as a diagnostic and a prognostic indicator in MF. METHODS We retrospectively investigated the electronic medical records of 97 patients with MF admitted to the Dermatology Clinic of Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital between January 2014 and December 2020. In total, 60 patients with MF were enrolled in the study. CAR was evaluated, patient and control group. Also, the other clinicopathological factors including age, lactate dehydrogenase, stage of disease, beta-2-microglobulin levels, and sedimentation levels were evaluated. RESULTS The median value of CAR was 0.85 (0.10-7.51) in the patient group, whereas it was 0.39 (0.0-1.11) in the control group (P < 0.001). Patients with disease progression (N = 16, 13M, 3 F) had a median value of CAR 0.84 (0.10-7.51) and the median value of CAR (N = 44) was 0.86 (0.12-4.57) in the group of patients with stable disease. The CAR value had no prognostic significance (P > 0.05). CONCLUSIONS There is no association between the CAR and progression in the stage in MF patients. But the CAR is significantly higher in patients with MF than in the control group. The CAR can be a guide for us in cases where we have difficulty in diagnosing.
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Affiliation(s)
- Gamze Taş-Aygar
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, Turkey
| | - Hatice Ataş
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, Turkey
| | - Müzeyyen Gönül
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, Turkey
| | - Selda Pelin Kartal
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, Turkey
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Goodrose-Flores C, Bonn SE, Klasson C, Frankling MH, Lagerros YT, Björkhem-Bergman L. Appetite and its association with mortality in patients with advanced cancer - a Post-hoc Analysis from the Palliative D-study. BMC Palliat Care 2023; 22:159. [PMID: 37880704 PMCID: PMC10601273 DOI: 10.1186/s12904-023-01287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Loss of appetite is a common nutrition symptom in patients with cancer. Understanding the trajectory of appetite could be of clinical use for prognostication in palliative cancer care. Our primary aim was to explore the association between self-assessed appetite and mortality in patients suffering from advanced cancer. Secondary aims included the relation between fatigue, albumin levels and CRP/albumin ratio and mortality. We also aimed to study potential sex-differences in the associations. METHODS Post-hoc analyses were performed using data from the Palliative D-study comprising 530 patients with cancer admitted to palliative care. Appetite and fatigue were assessed with the Edmonton Symptom Assessment System (ESAS). Cox proportional hazards models were used to calculate Hazard ratios (HR) with 95% confidence intervals (CI) for exposures of appetite, fatigue, albumin and CRP/albumin ratio, and time from study inclusion to death or censoring. Analyses were also performed stratified by sex. RESULTS The follow-up time ranged between 7 to 1420 days. Moderate and poor appetite were significantly associated with a higher mortality rate compared to reporting a good appetite; HR 1.44 (95%CI: 1.16-1.79) and HR 1.78 (95%CI: 1.39-2.29), respectively. A higher mortality rate was also seen among participants reporting severe fatigue compared to those reporting no fatigue; HR 1.84 (95%CI:1.43-2.36). Participants with low albumin levels (< 25 g/L) and those in the highest tertile of CRP/albumin ratio, had higher mortality rates, HR 5.35 (95%CI:3.75-7.63) and HR 2.66 (95%CI:212-3.35), compared to participants with high albumin levels (> 36 g/L) and those in lowest tertile of CRP/albumin ratio. These associations were more pronounced in men than in women. CONCLUSION Poor appetite, severe fatigue, low albumin level and a high CRP/albumin ratio were associated with increased mortality rates among patients with advanced cancer. All these variables might be clinically useful for prognostication in palliative cancer care. TRIAL REGISTRATION Clinicaltrial.gov. Identifier: NCT03038516;31, January 2017.
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Affiliation(s)
- Charlotte Goodrose-Flores
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden.
| | - Stephanie E Bonn
- Department of Medicine, Division of Clinical Epidemiology (KEP), Solna, Karolinska Institutet, Stockholm, Sweden
| | - Caritha Klasson
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Maria Helde Frankling
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Thoracic Oncology Center, Theme Cancer, Solna, Stockholm, SE-171 64, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine, Division of Clinical Epidemiology (KEP), Solna, Karolinska Institutet, Stockholm, Sweden
- Center of Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-122 19, Stockholm, Sweden
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Li Q, Zhang D, Sui X, Song T, Hu L, Xu X, Wang X, Wang F. The Warburg effect drives cachectic states in patients with pancreatobiliary adenocarcinoma. FASEB J 2023; 37:e23144. [PMID: 37584661 DOI: 10.1096/fj.202300649r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023]
Abstract
We have studied whether the Warburg effect (uncontrolled glycolysis) in pancreatobiliary adenocarcinoma triggers cachexia in the patient. After 74 pancreatobiliary adenocarcinomas were removed by surgery, their glucose transporter-1 and four glycolytic enzymes were quantified using Western blotting. Based on the resulting data, the adenocarcinomas were equally divided into a group of low glycolysis (LG) and a group of high glycolysis (HG). Energy homeostasis was assessed in these cancer patients and in 74 non-cancer controls, using serum albumin and C-reactive protein and morphometrical analysis of abdominal skeletal muscle and fat on computed tomography scans. Some removed adenocarcinomas were transplanted in nude mice to see their impacts on host energy homeostasis. Separately, nude mice carrying tumor grafts of MiaPaCa-2 pancreatic adenocarcinoma cells were treated with the glycolytic inhibitor 3-bromopyruvate and with emodin that inhibited glycolysis by decreasing hypoxia-inducible factor-1α. Adenocarcinomas in both group LG and group HG impaired energy homeostasis in the cancer patients, compared to the non-cancer reference. The impaired energy homeostasis induced by the adenocarcinomas in group HG was more pronounced than that by the adenocarcinomas in group LG. When original adenocarcinomas were grown in nude mice, their glycolytic abilities determined the levels of hepatic gluconeogenesis, skeletal muscle proteolysis, adipose-tissue lipolysis, and weight loss in the mice. When MiaPaCa-2 cells were grown as tumors in nude mice, 3-bromopyruvate and emodin decreased tumor-induced glycolysis and cachexia, with the best effects being seen when the drugs were administered in combination. In conclusion, the Warburg effect in pancreatobiliary adenocarcinoma triggers cancer cachexia.
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Affiliation(s)
- Qiuju Li
- The Graduate School, Tianjin Medical University, Tianjin, China
| | - Dapeng Zhang
- Tianjin Institute of Integrative Medicine for Acute Abdominal Diseases, Nankai Hospital, Tianjin, China
| | - Xiaojun Sui
- Tianjin Institute of Integrative Medicine for Acute Abdominal Diseases, Nankai Hospital, Tianjin, China
| | - Tao Song
- Tianjin Institute of Integrative Medicine for Acute Abdominal Diseases, Nankai Hospital, Tianjin, China
| | - Lijuan Hu
- Tianjin Institute of Integrative Medicine for Acute Abdominal Diseases, Nankai Hospital, Tianjin, China
| | - Xiaoqing Xu
- The Graduate School, Tianjin Medical University, Tianjin, China
| | - Ximo Wang
- Tianjin Institute of Integrative Medicine for Acute Abdominal Diseases, Nankai Hospital, Tianjin, China
- Haihe Hospital, Tianjin, China
| | - Feng Wang
- Tianjin Institute of Integrative Medicine for Acute Abdominal Diseases, Nankai Hospital, Tianjin, China
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Björkhem-Bergman L. Overtreatment in end-of-life care: how can we do better? Acta Oncol 2022; 61:1435-1436. [PMID: 36622891 DOI: 10.1080/0284186x.2023.2164919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Linda Björkhem-Bergman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden.,Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Cunha GDC, Rosa KSDC, Wiegert EVM, de Oliveira LC. Clinical Relevance and Prognostic Value of Inflammatory Biomarkers: A prospective Study in Terminal Cancer Patients Receiving Palliative Care. J Pain Symptom Manage 2021; 62:978-986. [PMID: 33895281 DOI: 10.1016/j.jpainsymman.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Inflammatory biomarkers have prognostic value in cancer patients, but the feasibility of their use with terminal cancer patients and the related cutoff points are poorly explored. OBJECTIVES To describe the percentiles values of inflammatory biomarkers; to identify their cutoff points in relation to death; and to determine the prognostic value of C-reactive protein (CRP), leukocytes, neutrophils, neutrophil/lymphocyte ratio (NLR), CRP/albumin ratio (CAR), and modified Glasgow Prognostic Score for death within 90 days, in terminal cancer patients receiving palliative care. METHODS Prospective cohort study that included patients who received palliative care at the Palliative Care Unit of the National Cancer Institute (Brazil) between October 2019 and March 2020. Receiver operating characteristic curves were used to identify the optimal cutoff points of the inflammatory biomarkers for the prediction of death in 90 days. Kaplan-Meier curves and Cox regression were used to verify the prognostic value of these cutoff points and concordance statistic (C-statistic) was used to test their predictive accuracy. RESULTS A total 205 patients (mean age: 62.5 years; female: 59%) were included in the study. The optimal cutoff points were CRP ≥6.7mg/L, CAR ≥2.0, leukocytes ≥9300/μL, neutrophils ≥7426/μL and NLR ≥6.0. All biomarkers showed prognostic value and good predictive accuracy when their cutoff points were used, especially CAR, which presented excellent discrimination power (C-statistic: 0.80). CONCLUSION The inflammatory biomarkers analyzed are independent predictive factors for death within 90 days in terminal cancer patients. CAR appears to be the most useful parameter for predicting survival in these patients.
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Affiliation(s)
- Gabriella da Costa Cunha
- Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Karla Santos da Costa Rosa
- Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | | | - Livia Costa de Oliveira
- Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil.
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C-reactive protein/albumin ratio in patients with multiple sclerosis and its relationship with disease subtype and disability. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.736846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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