Differences in routine laboratory parameters related to cachexia between patients with hematological diseases and patients with solid tumors or heart failure – is there only one cachexia?

Abstract

BackgroundCachexia is a state of involuntary weight loss common to many chronic diseases. Experimental data, showing that cachexia is related to the enhancement of acute phase response reaction, led to the new definition of cachexia that included, aside from the principal criterion of weight loss, other “minor criteria”, Amongst them are levels of C-reactive protein (CRP), albumin and hemoglobin. However, there is paucity of data regarding possible differences of these laboratory parameters in patients with various diseases known to be related to cachexia.MethodsCRP, albumin and hemoglobin were evaluated in 119 patients, divided into two disease groups, hematological (ones with diagnosis of non-Hodgkin lymphoma or Hodgkin disease) and non-hematological (solid tumor patients and patients with chronic heart failure). Patients were further subdivided into two nutritional groups, cachectic and non-cachectic ones according to the principal criterion for cacxehia i.e. loss of body weight.ResultsWe found that cachectic patients had higher levels of CRP, and lower levels of both hemoglobin and albumin compared to non-cachectic patients, regardless of the disease group they fitted. On the other hand, the group of hematological patients had lower levels of CRP primarily due to the differences found in the non-cachectic group. Higher levels of albumin were also found in the hematological group regardless of the nutritional group they fitted. Limitations of cut-off values, proposed by definition, were found, mostly regarding their relatively low sensitivity and low negative predictive value.ConclusionsAs expected, differences in values of routine laboratory parameters used in definition of cachexia were found between cachectic and non-cachectic patients. Their values differed between hematological and non-hematological patients both in cachectic and non-cachectic group. Cut-off levels currently used in definition of cachexia have limitations and should be further evaluated.

The prevalence of deranged C-reactive protein and albumin in patients with incurable cancer approaching death

“…Although many studies involve palliative cancer patients, to our knowledge no other study has specifically studied CRP and s-alb values in patients during their last 2 months of life. This could perhaps explain why the laboratory measures in this study population were more deranged than what has been seen in other studies [ 5 , 12 , 27 ]. A correlation between CRP and survival has been found in previous studies [ 28 , 29 ].…”

“…However, CRP and s-alb can be considered valid markers of systemic inflammation and also as a part of the criteria for cancer cachexia [ 24 ]. As mentioned above there is no consensus regarding the cut offs for these measures, however >5–10 for CRP and <32–35 for s-alb have been used in other studies [ 12 , 18 , 25 , 26 ]. The cut offs used in this study may therefore be considered to be relatively strict, furthermore the results also propose that the cut off for CRP could potentially be made even more strict, as CRP values in general were found to be remarkably elevated.…”

“…It is associated with decreased physical function and shortened survival [ 5 , 7 ], however the term lacks a universally accepted definition and there is no true consensus regarding which variables are to be measured [ 8 ]. The condition is generally defined as a certain percentage of weight loss (2–20%) over a certain period of time (3–12 months), elevated C-reactive protein (CRP) >5–10 mg/L and lowered s-albumin (s-alb) <32–35 g/L are sometimes included as”minor criteria”[ 8 – 12 ]. The latest stage of cachexia is referred to as refractory cachexia, a stage with a duration of survival less than 3 months that cannot be reversed by conventional nutritional support and that is unresponsive to anticancer treatment [ 3 ].…”

Influence of additional criteria from a definition of cachexia on its prevalence—good or bad thing?

“…20 Our working group also strongly believes in cachexia being a disease-specific condition. 21 Yet, our clinical practice consists of patients with various diseases related to cachexia. This makes generic definitions attractive and more practical to us.…”

Two ghrelin receptor agonists for adults with malnutrition: a systematic review and meta-analysis

“…The loss of lean and fat tissue may be associated with weight loss; such involuntary weight loss has been termed cachexia [49]. Activation of the GHS-R exerted anabolic functions and could lead to weight gain [41].…”