Inflammatory Nutritional Index Research Articles

A nomogram to predict the risk of colorectal anastomotic leakage combining inflammatory-nutritional and abdominal aorta calcium index.

Anastomotic leakage is a serious complication after colorectal cancer surgery, which affects the quality of life and the prognosis. This study aims to create a novel nomogram to predict the risk of anastomotic leakage for patients with colorectal cancer based on the preoperative inflammatory-nutritional index and abdominal aorta calcium index. 292 patients at Tianjin Medical University General Hospital (Tianjin, China) from January 2018 to October 2021 who underwent colorectal cancer surgery with a primary anastomosis were retrospectively reviewed. A nomogram was constructed based on the results of multivariate logistic regression model. The calibration curves and receiver operating characteristic curves were used to verify the efficacy of the nomogram. Univariate and multivariate analyses showed that tumor location (P = 0.002), preoperative albumin (P = 0.006), preoperative lymphocyte (P = 0.035), preoperative neutrophil to lymphocyte ratio (P = 0.024), and superior mesenteric artery calcium volumes score (P = 0.004) were identified as the independent risk factors for postoperative anastomotic leakage in patients with colorectal carcinoma. A nomogram was constructed based on the results of the multivariate analysis, and the C-index of the calibration curves was 0.913 (95%CI: 0.870-0.957) in the training cohort and 0.840 (95%CI: 0.753-0.927) in the validation cohort. The nomogram, combining basic variables, inflammatory-nutritional index and abdominal aorta calcium index, could effectively predict the possibility of postoperative anastomotic leakage for patients with colorectal cancer, which could guide surgeons to carry out the appropriate treatment for the prevention of anastomotic leakage.

Evaluation of Anemic Pupils Nutritional Status Fed with Recipes Based on Sweet Potatoes, Soya and Cowpea in Nawa Region, Côte d’Ivoire

In underdeveloped countries a great number of school-age children suffered of malnutrition and anemia. This is due to a less diversified diet and had an impact on their intellectual capacities. A study was conducted in four schools in Nawa region of Cote d’Ivoire with the aim to evaluate the impact of selected foods on anemic children nutritional status. One meal was proposed by school: rice with tomato sauce and meat, sweet potatoes stew with soya, sweet potatoes stew with cowpea and sweet potatoes stew with soya and cowpea. A total of 75 children aged from 6 to 15 years old participate, and they ate the meals twice in a week for 3 months. Anthropometric measurements (weight and height) and blood sampling were taken at 3 periods: at the beginning, middle and end of the study. The results showed that hemoglobin values were under normal rate for all children except in Petit-Bondoukou and Takoreagui in period 1 (11.67 and 11.82 g/dl respectively). There was an increase of anemia prevalence from 18.18 % to 40.91 % for children who ate rice with tomato sauce and meat and from 43.75 % to 50.00 % for children who ate potatoes stew with cowpea. But there was a decrease of anemia rate from 61.54 % to 53.83 % for children who ate potatoes stew with soya. Nutritional status according to anthropometric measurement increased for children of Gnaboya and Petit-Bondoukou. Albumin (33.25 g/l) and orosomucoid (0.69 mg/l) value of children who ate tomato sauce and meat were lower in period 1 than that of children of the other villages. According to prognostic inflammatory nutritional index, children present a low malnutrition risk which varied between 7.69 to 43.75 %. Diet diversification should be applied for a long period to better appreciate their impact on nutritional and anemia status improvement.

Evaluation of the relationship between serum ghrelin levels and cancer cachexia in patients with locally advanced nonsmall-cell lung cancer treated with chemoradiotherapy.

Ghrelin plays a role in mechanisms related to cancer progression - including cell proliferation, invasion and migration, and resistance to apoptosis in the cell lines from several cancers. We investigated the role of ghrelin levels in cancer cachexia-anorexia in patients with locally advanced nonsmall-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT). This study involved 84 NSCLC patients who had received concomitant CRT. Blood ghrelin levels were compared before and 3 months after CRT. Meanwhile, changes in body weight of the patients were also investigated with changes in ghrelin levels before and after CRT. Ghrelin levels were significantly decreased in line with changes in patients' weights in patients receiving CRT (P < 0.001). Serum albumin levels and inflammatory-nutritional index were significantly decreased after radiotherapy (RT) (3.01 ± 0.40 g/dL, 0.38 ± 0.20) when compared with its baseline levels (3.40 ± 0.55 g/dL,P < 0.001; 0.86 ± 0.71,P < 0.001, respectively). Serum C-reactive protein levels were significantly increased after CRT (7.49 ± 6.53 mg/L) when compared with its baseline levels (9.54 ± 3.80 mg/L,P = 0.038). After RT, ghrelin levels in patients were positively correlated with body mass index (r = 0.830,P < 0.001) and albumin (r = 0.758,P < 0.001). Ghrelin may play a role in the pathogenesis of weight loss in NSCLC patients. Ghrelin seems to be implicated in cancer-related weight loss. Ghrelin, cancer, and RT all together have a role in tumor-related anorexia-cachexia in patients with NSCLC. Results of this study need further evaluation as regards to its potential role as an adjuvant diagnostic or prognostic marker.

Evaluation of the relationship between serum ghrelin levels and cancer cachexia in patients with locally advanced nonsmall-cell lung cancer treated with chemoradiotherapy

Ghrelin plays a role in mechanisms related to cancer progression - including cell proliferation, invasion and migration, and resistance to apoptosis in the cell lines from several cancers. We investigated the role of ghrelin levels in cancer cachexia-anorexia in patients with locally advanced nonsmall-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT).This study involved 84 NSCLC patients who had received concomitant CRT. Blood ghrelin levels were compared before and 3 months after CRT. Meanwhile, changes in body weight of the patients were also investigated with changes in ghrelin levels before and after CRT.Ghrelin levels were significantly decreased in line with changes in patients' weights in patients receiving CRT (P < 0.001). Serum albumin levels and inflammatory-nutritional index were significantly decreased after radiotherapy (RT) (3.01 ± 0.40 g/dL, 0.38 ± 0.20) when compared with its baseline levels (3.40 ± 0.55 g/dL,P < 0.001; 0.86 ± 0.71,P < 0.001, respectively). Serum C-reactive protein levels were significantly increased after CRT (7.49 ± 6.53 mg/L) when compared with its baseline levels (9.54 ± 3.80 mg/L,P = 0.038). After RT, ghrelin levels in patients were positively correlated with body mass index (r = 0.830,P < 0.001) and albumin (r = 0.758,P < 0.001).Ghrelin may play a role in the pathogenesis of weight loss in NSCLC patients. Ghrelin seems to be implicated in cancer-related weight loss. Ghrelin, cancer, and RT all together have a role in tumor-related anorexia-cachexia in patients with NSCLC. Results of this study need further evaluation as regards to its potential role as an adjuvant diagnostic or prognostic marker.

Consumption of an Extremely Biodiverse Probiotic and a Supplement based on Microbial Chondroitin Sulfate is Associated with Very Low Serum Alpha-N-acetylgalactosaminidase (Nagalase) Activity and Decrease of C-reactive Protein Values

We describe the case of a 57-years-old male healthy professional who added to his nutritional plan a novel, extremely biodiverse, probiotic and a supplement based on microbial chondroitin sulfate, vitamin D3 and ultrapure phosphatidylcholine to improve his healthy life expectancy. After three months of such a nutritional regimen, serum alpha-N-acetylgalactosaminidase (nagalase) activity was 0.40 that is a value below the minimum level established for adults (normal values: 0.50-0.95 nMol/mL/min). C-reactive Protein (CRP) was less than 1 (normal values: 0.00-5.00 mg/L), a value significantly lower than that recorded before this experience. At the end of the observation period, serum albumin level was 45 g/L, a value very close to the maximum reference value (normal values: 32.00-46.00 g/L). The Prognostic Inflammatory Nutritional Index (PINI) score was 0.05, a value that is close to the minimum calculated value (normal values: 0.00-1.00) and suggests a very low risk of death for all causes. Observation in silico and experiments in vitro demonstrated that both the probiotic and the supplement formed complexes with human nagalase with an efficiency 100 fold higher than that of purified Gc protein-derived Macrophage Activating Factor (GcMAF). The collection of these observations suggests that the combination of this probiotic and this supplement may lead to overall beneficial effects on health as evidenced by positive changes of indicators of immune system function and healthy aging such as nagalase, CRP, albumin and PINI score.

The diagnosis and NUTRIC score of critically ill patients in enteral nutrition are risk factors for the survival time in an intensive care unit?

Objective: to investigate whether the caloric and protein deficits, the diagnosis and the NUTRIC score, behaved as risk factors associated to the survival time. Methods: prospective study with 82 critically ill patients in intensive care unit (ICU), with exclusive enteral nutritional therapy (EENT). We investigated the calorie and protein deficiencies of EENT, the NUTRIC score, and the inflammatory-nutritional index by the C-reactive protein-CRP/albumin. The data were analyzed using the Chi-square, Fisher, Mann-Whitney, Kruskal-Wallis, univariate and multiple Cox regressions and the Kaplan-Meyer method. Results: in the univariate Cox regression, one-year increase in age increased the risk of death by 4.1% (p=0.0009; HR=1.041) and one-day increase with intercurrent events, by 1.8% (p = 0.0485; HR = 1.018). In the multiple Cox regression, the clinical diagnosis (p = 0.0462, HR = 2.091) and the NUTRIC score ≥ 5 (p < 0.0001; HR = 5.740) were the variables that together were associated with the survival time. The critical caloric and protein deficits did not behave as death risk factors in this population. Kaplan-Meier curves showed that the probability of survival in 40 days was 28.1% with clinical diagnosis and 40.2% with surgical diagnosis. The mean survival time with NUTRIC score ≥ 5 was 17.4 days. The probability of survival at 40 days was 72.8% with NUTRIC score < 5 and 6.4% with NUTRIC score ≥ 5. Conclusion: caloric and protein deficits are not risk factors for mortality. Only the diagnosis and the NUTRIC score were considered risk factors associated with the survival time.

Inflammatory and nutritional statuses of patients submitted to resection of gastrointestinal tumors.

to evaluate the association between the nutritional and the inflammatory statuses of patients with cancer of the gastrointestinal tract undergoing surgical resection and to identify predictors of mortality in these patients. we conducted a prospective study of 41 patients with gastrointestinal tract cancer submitted to surgery between October 2012 and December 2014. We evaluated the nutritional status by subjective and objective methods. We assessed the inflammatory response and prognosis using the modified Glasgow Prognostic Score (mGPS), Neutrophil/Lymphocyte Ratio (NLR), Onodera Prognostic Nutritional Index (mPNI), Inflammatory-Nutritional Index (INI) and C-Reactive Protein/Albumin ratio (mPINI). half of the patients were malnourished and 27% were at nutritional risk. There was a positive association between the percentage of weight loss (%WL) and the markers NLR (p=0.047), mPINI (p=0.014) and INI (p=0.015). Serum albumin levels (p=0.015), INI (p=0.026) and mPINI (p=0.026) were significantly associated with the PG-SGA categories. On multivariate analysis, albumin was the only inflammatory marker independently related to death (p=0.004). inflammatory markers were significantly associated with malnutrition, demonstrating that the higher the inflammatory response, the worse the PG-SGA (B and C) scores and the higher the %WL in these patients. However, further studies aimed at improving surgical outcomes and determining the role of these markers as predictors of mortality are required.

Association Between Nutritional Status, Inflammatory Condition, and Prognostic Indexes with Postoperative Complications and Clinical Outcome of Patients with Gastrointestinal Neoplasia

ABSTRACTThe aim of this study is to describe and relate nutritional and inflammatory status and prognostic indexes with postoperative complications and clinical outcome of patients with gastrointestinal malignancies. Twenty-nine patients were evaluated; nutritional assessment was carried out by subjective and objective parameters; albumin, pre-albumin, C-reactive protein (CRP), and alpha-1-acid glycoprotein (AGP) were determined. To assess prognosis, the Glasgow scale, the Prognostic Inflammatory Nutritional Index (PINI), and CRP/albumin ratio were used; the clinical outcomes considered were hospital discharge and death. A high Subjective Global Assessment (SGA) score was associated with the occurrence of postoperative complications: 73% of the patients with postoperative complications had the highest SGA score, but only 6% of those without postoperative complications had the highest SGA score (P < 0.001). Greater occurrence of death was observed in patients with a high SGA score, low serum albumin, increased CRP, PINI > 1, and Glasgow score 2. There was a positive correlation between weight loss percentage with serum CRP levels (P = 0.002), CRP/albumin (P = 0.002), PINI (P = 0.002), and Glasgow score (P = 0.000). This study provides evidence that the assessment of the nutritional status and the use of prognostic indexes are good tools for predicting postoperative complications and clinical outcome in patients with gastrointestinal neoplasia.

The Inflammatory-Nutritional Index; assessing nutritional status and prognosis in gastrointestinal and lung cancer patients.

To evaluate the prognostic capacity of the Inflammatory-Nutritional Index (INI) in gastrointestinal and lung cancer patients. Longitudinal study, including patients from a chemotherapy service in Brazil, between July 2008 and May 2010. INI (Albumin/CRP) and nutritional status (by Subjective Global Assessment - SGA) were evaluated. Risk INI was defined as lower than 0.35. The mean follow-up of survival was 1.6 year. Statistical analyses were performed using Stata 11.1™. 74 patients participated in the study, mean age 63.4, most of them male (58%) and presenting gastrointestinal cancer (71%). Malnutrition was identified in 87% of the patients (22% severely malnourished). The mean INI was 2.67 and 54% of the patients had INI levels considered as risk. During the follow-up there were 49 deaths (66%). The median survival time for INI risk patients was significantly shorter than for normal INI ones (p = 0,002). It took 0.78 year for the INI risk subsample to decline 50%, while it took 2.78 year for the normal INI subsample. INI risk and severe malnutrition were independent predictors for poor survival. The INI showed prognostic capacity in this sample and may be a useful tool, based on routinely available blood tests, to assess cancer patients.

Assessment of Nutritional Status and Prognosis in Surgical Intensive Care Unit: The Prognostic and Inflammatory Nutritional Index (PINI)

Background Malnutrition is an independent factor of morbidity and mortality in patients at intensive care unit. The prognostic inflammatory and nutritional index (PINI) is frequently used as a marker of malnutrition but this scoring system was not studied in surgical intensive care units. The purposes of this study were to assist nutritional status with biomarkers and to search for a correlation between biological markers and prognosis, using the PINI. Methods A prospective, observational study was performed in the intensive care unit, started in July 2013. Twenty surgical patients, spent at least seven days at the intensive care unit were enrolled. An early nutritional care was given (first 24 hours). The patients were evaluated each week clinically and biologically (Albumin, Prealbumin, Orosomucoid, C-reactive protein) in order to establish the prognostic inflammatory and nutritional index (PINI = C-reactive protein x Orosomucoid / Albumin x Prealbumin). The correlation between variables was calculated, the Spearman rank-order correlation was used. Results The average age was 56+/-11 years, IGS II score was 48+/-17, APACHE II score was 25+/-12 and MODS ratio was 6+/-4. The mean duration of stay was 40+/-25 days, the mortality rate was 35%. The average calorie intake was 2300+/- 600 kcal. There was a weight gain and an increase of the Body Mass Index either in surviving and dead patients. There was an initial increase of the C-reactive protein and the orosomucoid rate during the acute phase of aggression followed by a progressive decrease. The nutritional proteins (albumin, prealbumin, retinol binding protein) were always low, despite a progressive increase. The PINI was initially high and decreased progressively but remained high (> 20).The Albumin and Prealbumin rate were correlated with the MODS ratio. There was a correlation between the orosomucoid rate and the organ failure. The PINI was correlated to the MODS ratio and to the IGS II but not with mortality. Conclusions The malnutrition in surgical patients at intensive care unit has an early onset and is always severe. Biological markers and PINI are correlated with organ failure but not with mortality.

Association between an inflammatory-nutritional index and nutritional status in cancer patients.

Cachexia is a multifatorial syndrome characterized by loss of body weight, fat and muscle, increasing morbidity and mortality. The use of an index accounting for both serum albumin and C Reactive Protein levels could make early identification of cachexia easier. To evaluate the variation of an inflammatory nutritional index related to nutritional status in cancer patients. Cross sectional study including patients with gastrointestinal and lung cancer of a public chemotherapy service in Brazil. Serum albumin and C Reactive Protein were measured and the nutritional status was defined by Subjective Global Assessment. Statistical analyses were performed using Stata 9.2(TM). A total of 74 patients were evaluated, 58.1% of them were male, mean age 63.4 ± 11.9 years old. Gastrointestinal cancer was the most prevalent type (71.6%). Only 13.7% of the patients were well nourished and 21.9% were severely malnourished. C Reactive Protein significantly increased according to nutritional status decline (p=0.03). When the albumin from patients with systemic inflammation was evaluated, there was no significant variation in relation to nutritional status (p=0.06). The Inflammatory Nutritional Index significantly varied in relation to nutritional status independent of the systemic inflammation (p=0.02). Inflammatory Nutritional Index can be an adjuvant way for biochemical nutritional assessment and follow up in cancer patients with systemic inflammation.

ROLE OF ANGIOTENSIN-CONVERTING ENZYME AND VITAMIN D RECEPTOR GENE POLYMORPHISMS IN CANCER ANOREXIA-CACHEXIA SYNDROME

The ubiquitin-proteasome pathway is a crucial conne ction between aberrant immune system activation, systemic inflammation and Cancer Anorexia-Cachexia Syndrome (CACS), a syndrome that culminates in hyper-activation of the ubiquitin-proteasome pathwa y. Angiotensin directly up-regulates this pathway, while vitamin D down-regulates it indirectly through the insulin-like growth factor-1 pathway. We investigat ed the genetic predisposition towards CACS in a cancer population, examining Insertion/Deletion (I/D) polymorphism of angiotensin-converting enzyme gene and FokI and BsmI polymorphisms of vitamin D receptor gene. Sixty-two cancer patients were recru ited and divided into three groups: primary cachect ic (C1, n = 14; dysmetabolic body weight loss ≥5% in 6 months); secondary cachectic (C2, n = 34; similar weight loss, mechanic or iatrogenic origin); and non-cachectic ( NC, n = 16). C2+NC were merged in the control group. The three groups showed significant differences in average prognostic inflammatory nutritional index ( C1: 26.4±23.4; C2: 5.4±5.6; NC: 0.37±0.5), C-reactive protein serum levels (C1: 6.6±2.1; C2: 2.4±2.2; NC: 1.0±2.0 mg/dl), albumin serum levels (C1: 3.1±0.6; C2: 3.5±0.4; NC 3.7±0.6 g/dl), weight loss (C1: 22±8; C2: 1 5±6.7; NC 5±6%) and life expectancy (C1: 6.4±3.3; C2: 25±28; NC: 45±25 months). However, none of the chosen polymorphisms showed any statistically significant correlation with CACS. The complexity of the changes of the immune system in the chronic inflammation state associated with CACS is far greater than expected and further studies are required to identify genetic independen t markers of progression toward CACS.

Malnutrition, Inflammation: Which Parameter Is Interesting to Detect in Planned Oncologic Surgery?

We are grateful to Dr. Muscaritoli and colleagues [1] for their comment and their recommendation concerning the need to assess inflammation parameters before surgery, especially C-reactive protein (CRP), and we totally agree with their advice. This point was recently confirmed in the study published this year by Moyes et al. [2], in which the Glasgow prognostic score (GPS) [3] using albumin (Alb) and C-reactive protein (CRP) values to determine the level of risk, was significantly associated with an increased risk of developing a postoperative infection during elective surgery in 385 colorectal cancer resections (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.17–2.63; p = 0.007). The goals of our study were to detect easily collected data on nutritional parameters that would allow us to define a group for which a nutritional treatment could reduce the number of complications after surgery. In the course of our study [4] CRP data were collected before surgery in 76% of the cases. Three CRP threshold values were studied: [15, [50, and 100 mg/l. In the univariate analysis, only a CRP value of [50 mg/l was found to be associated with total major complications (TMC) (p = 0.02), with major infectious complications (p = 0.03) and with major non-infectious complications (p = 0.05). No statistically significant relationship was found for a CRP value [15 mg/l or for CRP [ 100 mg/l. In the multivariate analysis, CRP was no longer associated with the occurrence of postoperative complications. We also analyzed the frequency of complications according to the Prognostic Inflammatory Nutritional Index: [PINI = CRP (mg/l) 9 orosomucoid (mg/l)]/[albumin g/ l 9 transthyretin (mg/l)], determined before surgery. Overall, PINI values were obtained for 72% of the patients. A relationship with the frequency of TMC was found only in the univariate analysis (p = 0.04), not in the multivariate analysis. As reported by some authors [5], as well as by Dr. Muscaritoli, albumin is dependent not only on the patient’s nutritional status but also on the inflammatory status. McMillan et al. [3] obtained better survival at 3 years in colorectal cancer patients using the GPS: 86% for a GPS 0 (Alb [ 35 g/l and CRP \ 10 mg l), 71% for a GPS 1 (Alb \ 35 g/l or CRP \ 10 mg/l), and 46% for a GPS 2 (Alb \ 35 g/l and CRP [ 10 mg/l) (p \ 0.0001). After analyzing our results according to the same threshold values, a similar role was found for the inflammatory factor. Major complications were more frequent (p = 0.03) for the highest GPS values; respectively, 23, 31, and 47% for a GPS of 0, 1, and 2. In the study by McMillan et al. [3], only 16/109 patients had an isolated low albumin level without elevation of CRP. The survival of these patients at 3 months (94%) was similar to that of the patients with a GPS 0 (84%). In our study, 14 patients had an Alb \ 35 without elevated CRP with 43% of TMC, and 35 patients had elevated CRP without a low albumin level with 29% of TMC. These groups were too small to allow statistical comparisons, but when we performed a chi square test adjusted for CRP, it showed that Alb was correlated with TMC (p = 0.02), whereas this was not the case for CRP when adjusted for Alb. The results of the multivariate analysis, as well as the chi square test, show that a low albumin level is a risk factor for TMC, independent of the inflammation status S. Antoun (&) A. Rey Institut Gustave-Roussy, Villejuif, France e-mail: sami.antoun@igr.fr

Prospective evaluation of clinical and biological parameters to predict clinically relevant denutrition in cancer patients undergoing surgery

18611 Background: Denutrition increases surgery morbidity and mortality in cancer patients. Methods: This study aimed to compare the relative value of different scores widely used to measure denutrition. During 3 months for all of the patients requiring heavy carcinologic surgery we checked: weight loss over 10%, body mass index (BMI), serum albumin, transthyretin (Tt), Buzby index, Pronostic Inflammatory Nutritional Index (PINI), Ottery score (PG-SGA). Other data like the surgical procedure, duration of surgery, cancer status were also recorded. Morbidity was defined by infectious and non-infectious major complications (IMC, NIMC), length of stay (Ls) in hospital, and death at 1 and 6 months. Results: 275 patients from 8 French Cancer Centers were included (167 were female, median age: 58 years). In multivariate analyses albumin level (&lt;30 g/l) is the only significant predictor of surgical morbidity, with the duration of the surgical procedure. Ottery score was the most sensitive among clinical parameters. Weight loss was significantly correlated with survival. Conclusions: Serum albumin and weight loss are useful parameters to consider in cancer patient requiring surgery; they are easy to monitor and should be part of pre-operative check-up in those patients. [Table: see text] No significant financial relationships to disclose.

Assessment of nutritional status and prognosis in advanced metastatic cancer (AMC) of gastrointestine (GI)

18573 Background: Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients (pts) with cancer. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The PINI (prognostic inflammatory nutritional index) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill pts. The aim of this study was designed to investigate the relationship between nutritional status after the palliative chemotherapy and prognosis in AMC of GI. Methods: This study included 130 pts with ECOG PS 1∼3 in AMC of GI following the palliative chemotherapy. ECOG PS, body mass index (BMI), alpha 1-acid glycoprotein (AGP), C-reactive protein (CRP), albumin (ALB), prealbumin (PALB), transferrin, protein, lactate dehydrogenase (LDH), PINI ratio [PINI = (AGP × CRP)/(ALB × PALB)], and survival time were evaluated. Results: In 130 patients, the median age was 57 years. The ECOG PS was 1: 68 patients, 2: 43 patients, 3: 19 patients. The mean value of PINI was PS 1: 16.0 ± 47.8, PS 2: 55.6 ± 106.9, PS 3: 106.3 ± 141.6. The mean survival was PS 1: 144.0 ± 71.8, PS 2: 68.9 ± 41.2, PS 3: 32.0 ± 6.9 days. In the PS 3 group, the mean values of AGP, CRP, and LDH were significantly higher than in the PS 1 group. In the PS 3 group, the mean values of ALB, PALB, and transferrin were significantly lower than in the PS 1 group. The survival time was correlated with the ECOG PS (r = −0.602, p &lt; 0.001,), PINI (r = −0.318, p &lt; 0.001,), AGP (r = −0.265, p = 0.002), CRP (r = −0.345, p &lt; 0.001), ALB (r = 0.324, p &lt; 0.001), PALB (r = 0.260, p = 0.003) and transferrin (r = 0.377, p = 0.001). Conclusions: The PINI should be considered nutritional status and prediction of prognosis in AMC of GI following palliative chemotherapy. [Table: see text] No significant financial relationships to disclose.

Assessment of nutritional status and prognosis in advanced metastatic cancer (AMC)

8146 Background: Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients (pts) with cancer. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The Prognostic Inflammatory Nutritional Index (PINI) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill pts. The PINI has been rarely evaluated in AMC. The aim of this study is to evaluate the interrelationships between the PINI and survival time (S), and performance status (PS) in pts with advanced solid malignancies following palliative chemotherapy. Methods: This study included 47 pts with PS (ECOG) 1–3 in AMC following palliative chemotherapy. PS, body mass index (BMI), alpha 1-acid glycoprotein (AGP), C-reactive protein (CRP), albumin (ALB), prealbumin (PALB), protein, LDH, PINI ratio [PINI = (AGP x CRP)/(ALB x PALB)], and S were evaluated. We investigated the interrelationships between PS and biochemical indices, PINI, and S. Results: In 47 pts, the median age was 60 yrs (40–69 yrs). The PS was: PS 1: 19 pts, PS 2: 17 pts, PS 3: 11 pts. The mean value of PINI was: PS 1: 7.4±13.4, PS 2: 78.0±155.0, PS 3: 145.6±173.0. The mean day of S was: PS 1: 108.8±49.6, PS 2: 50.9±20.1, PS 3: 20.2±18.3. In the PS 3 group, the mean values of AGP, and CRP were significantly higher than in the PS 1 group. In the PS 3 group, the mean values of ALB, and PALB were significantly lower than in the PS 1 group. However, BMI, Protein, and LDH were not significant. The severity of PS was correlated with the PINI (p=0.004, r=0.408), AGP (p=0.001, r=0.481), CRP (p=0.003, r=0.421), ALB (p<0.001, r=-0.517), PALB (p<0.001, r=-421), and S (p<0.001, r=-0.718). The value of PINI was correlated with S (p=0.004, r=-0.418). Conclusions: The PINI may be a useful scoring system for the assessment of nutritional status and prognosis. Altered nutritional and inflammatory status correlate with PS, and S following anticancer chemotherapy. No significant financial relationships to disclose.

Assessment of nutritional status and prognosis in advanced cancer: interleukin-6, C-reactive protein, and the prognostic and inflammatory nutritional index

The Prognostic Inflammatory Nutritional Index (PINI) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill patients. The PINI has never been evaluated in advanced cancer. Fifty consecutive patients with advanced cancer, weight loss, and anorexia were studied. C-reactive protein (CRP), albumin, pre-albumin, interleukin-6 (IL-6), and alpha 1-acid glycoprotein (AAG) were evaluated. The individual values for AAG, CRP, and IL-6 were markedly elevated. In contrast to albumin and prealbumin, CRP levels were very high. The PINI was significantly elevated, and higher than reported in critically ill intensive care patients. Elevated IL-6 levels correlated with high PINI and CRP values. CRP, IL-6, and PINI should be considered in future research on nutritional status and prediction of prognosis in advanced cancer.

Comparação entre a relação PCR/albumina e o índice prognóstico inflamatório nutricional (IPIN)

Objetivo: Simplificar o cálculo do índice prognóstico inflamatório nutricional (IPIN) empregando número menor de variáveis com conseqüente redução do custo da análise. Materiais e métodos: Foram estudados 54 pacientes e 12 indivíduos-controle com 48 ± 20 (média ± dp) anos de idade. As principais patologias dos pacientes eram: doença arterial periférica (22), pênfigo foliáceo (7), doença inflamatória intestinal (7), trauma (6) e pós-operatório de ortognatia (3). Foram obtidas amostras de sangue periférico, colhidas em jejum para dosagens de proteínas positivas (+) e negativas (-) de fase aguda (PFA) pelo método nefelométrico. Proteína C reativa (PCR), alfa-1-glicoproteína-ácida (alfa-1-GA), alfa-1-antitripsina (alfa-1-AT) e ceruloplasmina (CER) foram as PFA+ e albumina (Alb), transtiretina (TTR), transferrina (TF) e proteína ligadora do retinol (RBP) foram as representantes das PFA-. Esses valores foram analisados quanto à associação de correlação isolada ou associadamente na fórmula do índice prognóstico inflamatório e nutricional (IPIN = PCR + alfa-1-GA / Alb + TTR). De acordo com o índice prognóstico inflamatório e nutricional, os pacientes foram classificados em grupo-controle (G1); pacientes sem infecção/inflamação (IPIN < 1, G2) ou com risco de inflamação/infecção (IPIN > 1, G3). Em seguida os pacientes do G3 foram subdivididos em baixo risco (G3A, n = 16); médio risco ( G3B, n = 10); alto risco (G3C, n = 6) e com risco de morte (G3D, n = 11). Os resultados foram correlacionados entre si (teste de Spearman) ou submetidos às comparações entre grupos (teste de Kruskall-Wallis). Resultados: Houve relação significativa entre as variáveis PCR <FONT FACE=Symbol>´</FONT> alfa-1-GA (r = 0,49), Alb <FONT FACE=Symbol>´</FONT> TTR (r = 0,60), Alb <FONT FACE=Symbol>´</FONT> RBP (r = 0,58), Alb <FONT FACE=Symbol>´</FONT> TF (r = 0,39), TTR <FONT FACE=Symbol>´</FONT> RBP (r = 0,56) e TTR<FONT FACE=Symbol>´</FONT> TF (r = 0,43) e as melhores relações encontradas entre PFA+ e PFA- foram: PCR <FONT FACE=Symbol>´</FONT> Alb (r = - 0,71), PCR <FONT FACE=Symbol>´</FONT> TTR (r = - 0,54), PCR <FONT FACE=Symbol>´</FONT> TF (r = - 0,39) e alfa-1-GA <FONT FACE=Symbol>´</FONT> Alb (r = - 0,35). Os valores do IPIN mostraram a diferenciação G3 > (G1 = G2) e G3 > G3A. Entre todas as proteínas dosadas apenas PCR, Alb e TTR discriminaram os grupos: sendo G3 > (G1= G2) para PCR e G3< (G1= G2) para Alb e TTR. Apenas PCR, TTR e TF discriminaram a morbimortalidade com G3D > G3A (para PCR) e G3D < G3A (para TTR e TF). PCR/Alb e IPIN apresentaram concordância de valores para os riscos de complicações. Conclusão: Assim, conclui-se pela possibilidade de substituição do IPIN pela relação PCR/albumina, mais simples e de menor custo, mantendo-se o mesmo poder e sensibilidade para diagnóstico dos graus de risco de complicações.

Nutritional assessment: the prognostic and inflammatory nutritional index (PINI), inter-leukin-6 (IL-6), and c-reactive protein (CRP)

Nutritional assessment: the prognostic and inflammatory nutritional index (PINI), inter-leukin-6 (IL-6), and c-reactive protein (CRP)