The Prognostic Impact of C-reactive Protein and Albumin in Patients Diagnosed with Acute Myeloid Leukaemia

Overview

Journal EJHaem

Specialty Hematology

Date 2024 Dec 18

PMID 39691271

Authors

Espen Talseth Skar

Oystein Wendelbo

Hakon Reikvam

Affiliations

Soon will be listed here.

Abstract

Background: Acute myeloid leukaemia (AML) is an aggressive and heterogeneous malignant disease. Patient age, comorbidities and disease-specific genetic abnormalities are recognized as primary determinants of treatment response. Recent years have elucidated the significance of nutritional status and inflammation across various malignancies, including AML, in influencing treatment outcomes.

Aims: To assess the prognostic value of the C-reactive protein-albumin ratio (CAR) and the Glasgow Prognostic Score (GPS) in predicting overall survival (OS) rates among patients diagnosed with AML.

Material And Methods: 189 AML patients receiving standard cytarabine and anthracycline-based induction treatment were included. Baseline demographic, clinical and laboratory data were collected, and treatment outcomes and survival were registered for all patients.

Results: No significant association between CAR and prognosis among AML patients was found, even in subgroup analyses. Hypoalbuminemia was an independent predictor of poor survival among all patients (OS 28 vs. 16 months; < 0.02). Patients with a GPS of 0 or 1 demonstrated superior OS compared to those with a GPS of 2 (median OS 28 vs. 16 months, respectively; = 0.015). Results remained consistent among patients ≥ 60 years (median OS 15 vs. 6 months; = 0.020).

Conclusion: Heightened inflammation and suboptimal nutritional status correlate with unfavourable prognoses in AML patients. Such insights hold the potential for guiding clinical decision-making, offering easily accessible prognostic information for the induction treatment of eligible AML patients.

References

Senjo H, Onozawa M, Hidaka D, Yokoyama S, Yamamoto S, Tsutsumi Y . High CRP-albumin ratio predicts poor prognosis in transplant ineligible elderly patients with newly diagnosed acute myeloid leukemia. Sci Rep. 2022; 12(1):8885. PMC: 9133033. DOI: 10.1038/s41598-022-12813-1. View

Proctor M, Morrison D, Talwar D, Balmer S, OReilly D, Foulis A . An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer. 2011; 104(4):726-34. PMC: 3049591. DOI: 10.1038/sj.bjc.6606087. View

Crumley A, McMillan D, McKernan M, McDonald A, Stuart R . Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer. Br J Cancer. 2006; 94(5):637-41. PMC: 2361199. DOI: 10.1038/sj.bjc.6602998. View

McMillan D, Crozier J, Canna K, Angerson W, McArdle C . Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis. 2007; 22(8):881-6. DOI: 10.1007/s00384-006-0259-6. View

Liersch R, Muller-Tidow C, Berdel W, Krug U . Prognostic factors for acute myeloid leukaemia in adults--biological significance and clinical use. Br J Haematol. 2014; 165(1):17-38. DOI: 10.1111/bjh.12750. View

Tai C, Johnson T, Abbasi A, Herrell L, Harris W, Kucuk O . External validation of the modified Glasgow prognostic score for renal cancer. Indian J Urol. 2014; 30(1):33-7. PMC: 3897050. DOI: 10.4103/0970-1591.124203. View

Heini A, Hugo R, Berger M, Novak U, Bacher U, Pabst T . Simple acute phase protein score to predict long-term survival in patients with acute myeloid leukemia. Hematol Oncol. 2019; 38(1):74-81. DOI: 10.1002/hon.2696. View

Nozoe T, Matono R, Ijichi H, Ohga T, Ezaki T . Glasgow Prognostic Score (GPS) can be a useful indicator to determine prognosis of patients with colorectal carcinoma. Int Surg. 2014; 99(5):512-7. PMC: 4253916. DOI: 10.9738/INTSURG-D-13-00118.1. View

Berger M, Heini A, Seipel K, Mueller B, Angelillo-Scherrer A, Pabst T . Increased fibrinogen levels at diagnosis are associated with adverse outcome in patients with acute myeloid leukemia. Hematol Oncol. 2016; 35(4):789-796. DOI: 10.1002/hon.2307. View

10.

Pantano N, Paiva B, Hui D, Paiva C . Validation of the Modified Glasgow Prognostic Score in Advanced Cancer Patients Receiving Palliative Care. J Pain Symptom Manage. 2015; 51(2):270-7. DOI: 10.1016/j.jpainsymman.2015.09.010. View

11.

Yu Q, Li K, Fu Y, Tang Y, Liang X, Liang Z . Clinical significance and prognostic value of C-reactive protein/albumin ratio in gastric cancer. Ann Surg Treat Res. 2021; 100(6):338-346. PMC: 8176197. DOI: 10.4174/astr.2021.100.6.338. View

12.

Dohner H, Wei A, Appelbaum F, Craddock C, DiNardo C, Dombret H . Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood. 2022; 140(12):1345-1377. DOI: 10.1182/blood.2022016867. View

13.

Arakawa Y, Miyazaki K, Yoshikawa M, Yamada S, Saito Y, Ikemoto T . Value of the CRP-albumin ratio in patients with resectable pancreatic cancer. J Med Invest. 2021; 68(3.4):244-255. DOI: 10.2152/jmi.68.244. View

14.

Keller U . Nutritional Laboratory Markers in Malnutrition. J Clin Med. 2019; 8(6). PMC: 6616535. DOI: 10.3390/jcm8060775. View

15.

Dou L, Shi M, Song J, Niu X, Niu J, Wei S . The Prognostic Significance of C-Reactive Protein to Albumin Ratio in Newly Diagnosed Acute Myeloid Leukaemia Patients. Cancer Manag Res. 2022; 14:303-316. PMC: 8800567. DOI: 10.2147/CMAR.S343580. View

16.

Forrest L, McMillan D, McArdle C, Angerson W, Dunlop D . Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003; 89(6):1028-30. PMC: 2376960. DOI: 10.1038/sj.bjc.6601242. View

17.

Fan H, Shao Z, Xiao Y, Xie Z, Chen W, Xie H . Comparison of the Glasgow Prognostic Score (GPS) and the modified Glasgow Prognostic Score (mGPS) in evaluating the prognosis of patients with operable and inoperable non-small cell lung cancer. J Cancer Res Clin Oncol. 2016; 142(6):1285-97. DOI: 10.1007/s00432-015-2113-0. View

18.

Soeters P, Wolfe R, Shenkin A . Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr. 2018; 43(2):181-193. PMC: 7379941. DOI: 10.1002/jpen.1451. View

19.

Simmons C, Koinis F, Fallon M, Fearon K, Bowden J, Solheim T . Prognosis in advanced lung cancer--A prospective study examining key clinicopathological factors. Lung Cancer. 2015; 88(3):304-9. DOI: 10.1016/j.lungcan.2015.03.020. View

20.

Komura N, Mabuchi S, Shimura K, Kawano M, Matsumoto Y, Kimura T . Significance of Pretreatment C-Reactive Protein, Albumin, and C-Reactive Protein to Albumin Ratio in Predicting Poor Prognosis in Epithelial Ovarian Cancer Patients. Nutr Cancer. 2020; 73(8):1357-1364. DOI: 10.1080/01635581.2020.1798479. View