Clinical Relevance and Prognostic Value of Inflammatory Biomarkers: A prospective Study in Terminal Cancer Patients Receiving Palliative Care

Cunha, Gabriella da Costa; Rosa, Karla Santos da Costa; Wiegert, Emanuelly Varea Maria; Oliveira, Lívia Costa de

doi:10.1016/j.jpainsymman.2021.04.009

Cited by 10 publications

(16 citation statements)

References 29 publications

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“…To our knowledge, no studies have specifically studied longitudinal albumin, CRP, and CAR in an exclusive palliative setting. Concerning cross-sectional studies that involve patients with cancer in palliative care 4,8,9,29 median and cut-off values vary according to the cancer population and period analyzed which makes it difficult to compare our results with those observed in other previous studies.…”

Section: Discussionmentioning

confidence: 71%

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Changes in inflammatory biomarkers related to C-reactive protein and albumin in patients with terminal cancer receivin palliative care: a longitudinal study

Wiegert¹,

Lima²,

Cunha³

et al. 2022

BJOncology

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Background: Evidence about how inflammatory biomarkers vary during the end-stage cancer trajectory is lacking. This study investigates the longitudinal changes in albumin and C-reactive protein (CRP) levels, and CRP/albumin ratio (CAR) in patients with terminal cancer receiving palliative care in the last three months of life. Methods: This is a retrospective analysis of variables extracted from a prospective cohort study that included admitted patients to the exclusive Palliative Care Unit of the National Cancer Institute in Brazil. Routine blood examination results of albumin and CRP were recorded at 0-15 (T1), 16-30 (T2), 31-45 (T3), 46-60 (T4), 61-75 (T5), and 76-90 (T6) days before death and only patients with at least two measurements were included. Crude and adjusted linear mixed-effects regression models were performed to verify the relationships between the longitudinal trajectories of biomarkers and death. Results: A total of 1,635 patients were included. Median albumin was 3.00g/dL across the whole time-period analyzed (interquartile range, IQR: 2.50-3.60) and decreased with the approach of death, while median CRP was 9.31mg/L (IQR: 4.42-17.30) and CAR was 3.22 (IQR: 1.42-6.68), and both increased. The albumin (slope: all 0.01; p <0.001), CRP (slope: -0.10 to -0.13; p <0.001), and CAR (slope: -0.05 to -0.07; p <0.001) showed a linear doseresponse relationship with death in crude and adjusted models tested. Conclusions: The longitudinal change levels of inflammatory biomarkers worsen with the approach of death and could be used to predict end-stage in patients with terminal cancer.

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Section: Discussionmentioning

confidence: 71%

“…As for the 33 that related albumin to overall survival, the most common cutoff points studied were <3.5 g/dL (n= 13; 39.4%) and <3.0 g/dL (n= 5; 15.1%). According to the results of a meta-analysis by Li et al 7 different CAR cutoff points, ranging from 0.25 to 6.7, are used to describe the association between CAR and overall survival 29 .…”

Section: Discussionmentioning

confidence: 99%

Changes in inflammatory biomarkers related to C-reactive protein and albumin in patients with terminal cancer receivin palliative care: a longitudinal study

Wiegert¹,

Lima²,

Cunha³

et al. 2022

BJOncology

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show abstract

“…To our knowledge, no studies have speci cally studied longitudinal albumin, CRP, and CAR in an exclusive palliative setting. Concerning cross-sectional studies that involve patients with cancer in palliative care [4,8,9,29] median and cut-off values vary according to the cancer population and period analyzed which makes it di cult to compare our results with those observed in other previous studies.…”

Section: Discussionmentioning

confidence: 79%

Changes in Inflammatory Biomarkers Related to C-reactive Protein and Albumin in Patients With Terminal Cancer Receiving Palliative Care: a Longitudinal Study

Wiegert¹,

Calixto-Lima²,

Cunha³

et al. 2021

Preprint

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Background: Evidence about how inflammatory biomarkers vary during the end-stage cancer trajectory is lacking. This study investigates the longitudinal changes in albumin and C-reactive protein (CRP) levels, and CRP/albumin ratio (CAR) in patients with terminal cancer receiving palliative care in the last three months of life.Methods: This is a retrospective analysis of variables extracted from a prospective cohort study that included admitted patients to the exclusive Palliative Care Unit of the National Cancer Institute in Brazil. Routine blood examination results of albumin and CRP were recorded at 0-15 (T1), 16-30 (T2), 31-45 (T3), 46-60 (T4), 61-75 (T5), and 76-90 (T6) days before death and only patients with at least two measurements were included. Crude and adjusted linear mixed-effects regression models were performed to verify the relationships between the longitudinal trajectories of biomarkers and death. Results: A total of 1,635 patients were included. Median albumin was 3.00g/dL across the whole time-period analyzed (interquartile range, IQR: 2.50-3.60) and decreased with the approach of death, while median CRP was 9.31mg/L (IQR: 4.42-17.30) and CAR was 3.20 (IQR: 1.40-6.60), and both increased. The albumin (slope: 0.01 to 0.02; p <0.001), CRP (slope: -0.10 to -0.12; p <0.001), and CAR (slope: -0.06; p <0.001) showed a linear dose-response relationship with death in crude and adjusted models tested. Conclusions: The longitudinal change levels of inflammatory biomarkers worsen with the approach of death and could be used to predict end-stage in patients with terminal cancer.

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“…PNI was calculated as 10 × albumin (g/dL) + 0.005 × lymphocyte (/mm 3 ) (17). NLR was defined as the division of neutrophil count by lymphocyte count and CAR was defined as the division of CRP by albumin level (20)(21)(22)(26)(27)(28)(29)(30)(31).…”

Section: Prognostic Indicesmentioning

confidence: 99%

“…Recently, the CRP/albumin ratio (CAR) has been reported to be related to poor outcomes in various types of cancer (26)(27)(28)(29). The prognostic value of the CAR was also explored in advanced cancer patients receiving palliative care (30,31). Recently, our group reported that a simple anthropometric measure, 'mid-upper arm circumference (MUAC)', is an independent prognostic factor that can estimate 3-month survival in medical oncology outpatients (32).…”

Section: Introductionmentioning

confidence: 99%

Performance of mid-upper arm circumference and other prognostic indices based on inflammation and nutrition in oncology outpatients: a tertiary cancer center study

Kim¹,

Hiratsuka²,

Suh³

et al. 2022

Ann Palliat Med

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Background: We aimed to compare the performance of established inflammation and nutrition-based prognostic indices with a relatively novel index 'mid-upper arm circumference (MUAC)' in outpatients with advanced cancer.Methods: This study was a secondary analysis of a prospective cohort study that enrolled 200 outpatients with advanced cancer visiting a medical oncology clinic at a tertiary hospital. All patients were followed until death, and the Glasgow Prognostic Score (GPS), modified GPS (mGPS), Prognostic Nutritional Index (PNI), neutrophil/lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), and MUAC were compared by calculating the area under the receiver operating characteristic curves (AUROCs). Results:The mean age of the patients was 64.4 years, 64.0% were male, and the median overall survival was 32.4 weeks [95% confidence interval (CI): 5.6-142.7]. Overall, all indices showed similarly high AUROCs for estimating 12-week (0.68 to 0.75

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Clinical Relevance and Prognostic Value of Inflammatory Biomarkers: A prospective Study in Terminal Cancer Patients Receiving Palliative Care

Cited by 10 publications

References 29 publications

Changes in inflammatory biomarkers related to C-reactive protein and albumin in patients with terminal cancer receivin palliative care: a longitudinal study

Changes in inflammatory biomarkers related to C-reactive protein and albumin in patients with terminal cancer receivin palliative care: a longitudinal study

Changes in Inflammatory Biomarkers Related to C-reactive Protein and Albumin in Patients With Terminal Cancer Receiving Palliative Care: a Longitudinal Study

Performance of mid-upper arm circumference and other prognostic indices based on inflammation and nutrition in oncology outpatients: a tertiary cancer center study

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