High Serum Vitamin B12 Levels Associated with C-Reactive Protein in Older Patients with Cancer

Abstract

Background. A Comprehensive Geriatric Assessment (CGA) has been proposed to assess prognosis and to adapt oncological care in older patients with cancer. However, few biological markers are incorporated in the CGA. Methods. This comparative study on older patients with cancer was realized before final therapeutic decision and during a CGA that included biological markers. Our objective study was to know if the serum vitamin B12-C-reactive protein index (BCI) can help to estimate early death and unplanned hospitalization. Associations between BCI and unplanned hospitalization or mortality were analyzed using ordered multivariate logistic regression. Findings. We included 621 older cancer adults in outpatient care with a median age of 81 years (range, 70-98 years) from September 2015 to May 2018. In this study, 5.6% of patients died within 3 months, 8.8% had unplanned hospitalization within 1 month, and 11.4% had unplanned hospitalization within 3 months. Hypercobalaminemia was present in 83 patients (13.4%), and 34 patients (5.5%) had BCI >40,000. According to the multivariate analysis, BCI was a prognostic factor of mortality within 3 months and unplanned hospitalizations at 1 and 3 months. Impaired activities of daily living (ADL) and palliative care were also risk factors for mortality within 3 months. Impaired instrumental ADL, low albumin level, and palliative care were risk factors for unplanned hospitalization at 1 month. Interpretation. BCI could be routinely added to the CGA process, as part of a pretreatment workup, in order to assess more precisely the frailties and to adapt oncological care in older patients treated for cancer. The Oncologist 2020;25:1-10 Implications for Practice: Aging comes with an increase of frailties and comorbidities. To identify frailties in older patients with cancer, this study used a Comprehensive Geriatric Assessment, which allowed for the adaptation of each treatment plan in accordance with the individual needs of the patients. However, biological characteristics were not included in this assessment. This study showed that hypercobalaminemia and vitamin B12-C-reactive protein index may be potential markers for cancer with poor prognosis, particularly in the older population. These biological markers can be used in geriatric oncology and general medicine.

Association between Elevated Plasma Vitamin B12 and Short-Term Mortality in Elderly Patients Hospitalized in an Internal Medicine Unit

“…In the present study, this association remained signifcant after adjustment for cancer, BMI, albumin level, and ICU referral, suggesting B12 is an independent marker of poor prognosis. High B12 levels have been suggested as part of a frailty score in association with cancer, liver disease, or cardiovascular disease [36][37][38]. Indeed, if elevated B12 is independently associated with mortality, combining this with other poor prognostic factors such as low albumin or chronic disease is likely to improve its impact.…”

B12 levels and frailty syndrome

“…Finally, Couderc et al (2020) studied the effects of hypercobalaminemia in 621 older cancer adults in outpatient care with a median age of 81 years. Their study demonstrated that hypercobalaminemia and vitamin B12-C-reactive protein index may constitute important markers for older cancer frail patients with poor prognosis[ 34 ].…”

Challenges in the diagnosis of hypervitaminemia B12. Interference by immunocomplexes

“…Moreover, vitamin B12 has also been postulated as a useful biomarker of severity (prognosis) and death in such diseases [5][6][7], as well as, increased vitamin B12 concentrations might paradoxically be masking a deficiency [8]. This functional deficiency is associated with alterations in the uptake and tissue processing of cobalamin, or with the presence of antibodymediated analytical interferences such as macrocomplexes of vitamin B12 [macroB12, generally with immunoglobulins (immunocomplexes)] [9][10][11][12].…”