The Value of Nutritional Status in the Prognostic Analysis of Patients with AIDS-Related Lymphoma

Abstract

Objective Many studies have suggested that indexes of nutritional status, such as body mass index (BMI), serum albumin (ALB), serum pre-albumin (PA), and hemoglobin, may be used as risk factors for the prognosis of HIV or lymphoma. Therefore, this study aimed to retrospectively analyze and explore the value of nutritional status in the prognostic assessment of patients with AIDS-related lymphoma (ARL). Methods In this retrospective study, the clinical data of 69 patients with ARL were collected. All patients had a definite diagnosis of non-Hodgkin lymphoma by pathological examination and met the requirements of the Hematopoietic and Lymphocytic Tissue Tumor Classification (2016) established by the World Health Organization. Patients who did not receive standard chemotherapy, those with incomplete medical records, and those with an unclear pathological diagnosis were excluded. The patients were divided into two groups (survival and death) according to the prognostic outcome, and their clinical characteristics and prognoses were discussed by relevant statistical methods. Results During the three-year follow-up period, 20 (28.99%) patients died, and 49 (71.01%) survived. The one-year cumulative survival rate was 78.26%. A univariate analysis found that the prognosis was associated with the International Prognostic Index (IPI) score, BMI, ALB, PA, and CD4 T lymphocyte count. The Cox risk proportional regression analysis showed that the IPI score, BMI, and PA were the independent risk factors for survival; their combination had a greater ability to forecast the clinical outcome (area under the curve = 0.874, P < 0.001). Conclusion In this study, at the time of the visit, the patients with ARL tended to be in the advanced stages of disease and, therefore, at high risk of mortality. Therefore, their nutritional status might be of great value to the prognostic assessment. The combination of BMI, PA, and IPI scores could be used for risk stratification and better screening of high-risk patients.

A novel prediction model to evaluate the probability of CD4+/CD8+ cell ratio restoration in HIV-infected individuals

“…Although baseline T-cell status and age have been associated with the response of ratio restoration, ALB levels were not reported as such a variable. At present, several studies imply that markers of nutritional condition, such as BMI, ALB, and HGB, may be used as risk indicators for the prognosis of HIV/AIDS patients [32], and that hypoproteinemia is usually one of the typical characteristics of cachexia [33].…”

Prognostic value of albumin/lactate dehydrogenase ratio in AIDS-related lymphoma

“…ARL patients have a higher risk of immunode ciency and malnutrition. Studies have shown that low serum albumin levels are closely related to the poor prognosis of patients [13,14]. Studies have found that hypoalbuminemia are closely related chronic in ammation and may be related to cytokines interleukin-6 and tumor necrosis factor.…”

“…That suggest that ARL patients have poor nutritional status, heavy tumor burden, hypoxia, and high tumor resistance to chemoradiotherapy. Many studies have shown that low levels of albumin or high levels of LDH are associated with poor prognosis [11,13,14,17]. ARL patients should also pay attention to the schedule and timing of antiviral therapy and chemotherapy.…”

“…Serum albumin has protective properties, such as maintaining physiological homeostasis, antioxidant activity, anti-in ammatory effects, and preventing apoptosis [12]. Studies have shown that low serum albumin levels are closely related to poor prognosis in lymphoma patients [13,14]. The predictive value of a single lactate dehydrogenase and albumin is limited, and comprehensive indicators are needed to conduct more accurate risk strati cation and improve the predictive value.…”

Hypoalbuminemia predicts inferior outcome in patients with AIDS-related lymphoma

“…Recently, several biomarkers have been suggested to be related to the prognosis of ARL, including IPI, age-adjusted IPI, CD4 + T cells count, age, Eastern Cooperative Oncology Group performance status (ECOG PS), chemotherapy, lactate dehydrogenase (LDH), Epstein- barr virus deoxyribonucleic acid (EBV DNA), hepatitis C virus, the Burkitt/Burkitt-like lymphoma subtype, history of clinical AIDS, and expression of B-cell lymphoma-2 (BCL2), cluster of differentiation 4 (CD44), Protein 53 (p53) and Immunoglobulin M (IgM) [ 10 – 15 ]. Alternatively, recent immunosuppression and prolonged HIV viraemia have important independent roles in the development of ARL [ 16 ].…”