Almasaudi, A. S., Dolan, R. D. , Edwards, C. A. and McMillan, D. C. (2020) Hypoalbuminemia reflects nutritional risk, body composition and systemic inflammation and is independently associated with survival in patients with colorectal cancer. Cancers, 12(7), 1986. (doi: 10.3390/cancers12071986)
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Abstract
It has long been recognized that albumin has prognostic value in patients with cancer. However, although the Global Leadership Initiative on Malnutrition GLIM criteria (based on five diagnostic criteria, three phenotypic criteria and two etiologic criteria) recognize inflammation as an important etiologic factor in malnutrition, there are limited data regarding the association between albumin, nutritional risk, body composition and systemic inflammation, and whether albumin is associated with mortality independent of these parameters. The aim of this study was to examine the relationship between albumin, nutritional risk, body composition, systemic inflammation, and outcomes in patients with colorectal cancer (CRC). A retrospective cohort study (n = 795) was carried out in which patients were divided into normal and hypoalbuminaemic groups (albumin <35 g/L) in the presence and absence of a systemic inflammatory response C-reactive protein (CRP >10 and <10 mg/L, respectively). Post-operative complications, severity of complications and mortality were considered as outcome measures. Categorical variables were analyzed using Chi-square test χ 2or linear-by-linear association. Survival data were analyzed using univariate and multivariate Cox regression. In the presence of a systemic inflammatory response, hypoalbuminemia was directly associated with Malnutrition Universal Screening Tool MUST (p < 0.001) and inversely associated with Body Mass Index BMI (p < 0.001), subcutaneous adiposity (p < 0.01), visceral obesity (p < 0.01), skeletal muscle index (p < 0.001) and skeletal muscle density (p < 0.001). There was no significant association between hypoalbuminemia and either the presence of complications or their severity. In the absence of a systemic inflammatory response (n = 589), hypoalbuminemia was directly associated with MUST (p < 0.05) and inversely associated with BMI (p < 0.01), subcutaneous adiposity (p < 0.05), visceral adiposity (p < 0.05), skeletal muscle index (p < 0.01) and skeletal muscle density (p < 0.001). Hypoalbuminemia was, independently of inflammatory markers, associated with poorer cancer-specific and overall survival (both p < 0.001). The results suggest that hypoalbuminemia in patients with CRC reflects both increased nutritional risk and greater systemic inflammatory response and was independently associated with poorer survival in patients with CRC.
| Item Type: | Articles |
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| Additional Information: | This study was funded by Saudi education sponsors, King Abdulaziz university, Faculty of Applied Medical Science, Department of Clinical Nutrition, Jeddah, Saudi Arabia. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McMillan, Professor Donald and Edwards, Professor Christine and Dolan, Dr Ross and Almasaudi, Arwa |
| Creator Roles: | McMillan, D. C.Conceptualization, Methodology, Formal analysis, Investigation, Resources, Data curation, Writing – review and editing, Visualization, Supervision, Project administration Almasaudi, A. S.Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing – original draft, Writing – review and editing, Visualization, Funding acquisition Edwards, C. A.Conceptualization, Resources, Writing – review and editing, Visualization, Supervision, Project administration Dolan, R. D.Software, Validation, Resources, Data curation |
| Authors: | Almasaudi, A. S., Dolan, R. D., Edwards, C. A., and McMillan, D. C. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | Cancers |
| Publisher: | MDPI |
| ISSN: | 2072-6694 |
| ISSN (Online): | 2072-6694 |
| Published Online: | 21 July 2020 |
| Copyright Holders: | Copyright © 2020 The Authors |
| First Published: | First published in Cancers 12(7): 1986 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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