Low Serum Albumin Level Predicts the Risk of Azacitidine Early Discontinuation in MDS, CMML and 20-30% AML Patients- Results from the Polaza, the Retrospective Study of the Polish Adult Leukemia Group

Background: Azacitidine is the current standard of care for higher risk MDS patients (HR MDS) changing the natural course of diseases. Early drug discontinuation (receiving less than 4 azacitidine cycles - early failure - EF) is a poor prognostic marker, while factors affecting early failure are largely unknown. Objectives: To identify predictive factors for early azacitidine failure in MDS/CMML/low blast percentage AML patients Methods: The study included retrospectively MDS/CMML and 20-30% bone marrow blasts AML patients treated from 2008 to 2019 in 12 Polish hematologic centers cooperating within Polish Adult Leukemia Group (PALG). Baseline demographic, laboratory, clinical and treatment characteristics were obtained and were evaluated as potential EF predictors. Cox proportional hazard models were used to define statistical significance of variables using the R statistical platform. Results: We collected data on 315 patients with MDS (67%), CMML (12%) and with AML (21%). Median age was 69 years and 61% were male. Median number of azacitidine cycles was 7 (1-69) and 84 patients (29%) received maximum 3 cycles. Patients achieved more than 3 cycles showed better OS compared to those ≤ 3 cycles (20 months vs 4 months)(p<0.05)( Figure 1). In univariate analysis the following features were significantly predictive for early failure: poorer cytogenetics IPSS (OR 1.87, 95% CI 1.36-2.56; p<0.001), poorer cytogenetics IPSS R (OR 1.52, 95% CI 1.21-1.89; p< 0.001), poorer IPSS score (OR 1.77, 95% CI 1.18-2.66; p0.006), poorer ISS R score (OR 1.51, 95% CI 1.07-2.14; p=0.02), earlier treatment (OR 2.43, 95% CI 1.33-4.44; p=0.004), serum albumin level (OR 0.44, 95% CI 0.27-0.74; p=0.002), coexistence of autoimmune disease (OR 1.49, 95% CI 1.12-1.99; p=0.007), ECOG performance status (OR 1.49, 95% CI 1.12-1.99, p=0.007) and ativiral prophylaxis management (OR 0.40, 95% CI 0.19-0.87, p=0.020). In the multivariate analysis only serum albumin level retained its significance as independent factor affecting the risk of EF (OR 0.30, 95% CI 0.13-0.7; p=0.005). Decrease of albumin level by 1 g/dL rises the risk of EF occurence by 70%. Conclusions: Our analysis confirmed that patients with premature azacitidine treatment discontinuation ≤ 3 cycles have worse outcome. The pretreatment lower serum albumin level was identified as an independent predictor of early failure occurence. Figure 1. Overall survival in patients treated with ≤ 3 azacitidine cycles and > 3 cycles Disclosures Golos: Novartis: Honoraria. Basak:Celgene: Honoraria; Teva: Honoraria.

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Association between reduced preoperative serum albumin and prognosis in patients with adrenocortical carcinoma after primary resection: A retrospective study

10.21203/rs.3.rs-62897/v1 ◽

2020 ◽

Author(s):

Fuxun Zhang ◽

Zhihong Liu ◽

Jiayu Liang ◽

Shengzhuo Liu ◽

Kan Wu ◽

...

Keyword(s):

Multivariate Analysis ◽

Serum Albumin ◽

Adrenocortical Carcinoma ◽

Serum Albumin Level ◽

Statistical Significance ◽

Univariate Analysis ◽

Albumin Level ◽

Primary Resection ◽

Rank Test ◽

Preoperative Serum

Abstract Purpose To assess the correlation between preoperative serum albumin level and prognosis in patients with adrenocortical carcinoma after primary surgery. Methods We reviewed medical information of 71 included patients with diagnosis of ACC who underwent primary resection. Univariate and multivariate analysis were performed using Cox’s proportional hazards model. Survival analysis was conducted by Kaplan–Meier method with log-rank test. Receiver operating characteristic (ROC) curve and Jordan index were generated to explore cut-off value for serum albumin. Statistical significance was defined as P < 0.05. Results Among included patients, 33 patients (46.5%) relapsed at the end of follow-up, while 39 patients (54.9%) died. The median OS of overall included patients was 17 (range 1–104) months and median RFS was 10 (range 0–104) months. In univariate analysis, the albumin significantly associated with OS and RFS (HR:0.491, 95%CI: 0.260–0.930, P = 0.029 and HR:0.383, 95%CI: 0.192–0.766, P = 0.007, respectively). In multivariate analysis, the albumin level as an independent prognostic factor of OS was confirmed(HR:0.351, 95%CI: 0.126–0.982, P = 0.046). Meanwhile, the present results indicates the trend that albumin might be an independent predictor of RFS ( HR:0.423, 95%CI: 0.176–1.018, P = 0.055) Conclusion The preoperative serum albumin level is significantly correlated to prognosis of patients with ACC after primary resection. Reduced preoperative albumin level was proven to be a risk factor of clinical outcomes for ACC. Appropriate nutritional intervention prior to surgery may be beneficial to improve the prognosis of ACC patients.

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Impact of Nutritional Status on Peritonitis in CAPD Patients

Peritoneal Dialysis International ◽

10.1177/089686080702700110 ◽

2007 ◽

Vol 27 (1) ◽

pp. 42-47 ◽

Cited By ~ 40

Author(s):

Narayan Prasad ◽

Amit Gupta ◽

Raj K. Sharma ◽

Archna Sinha ◽

Ramesh Kumar

Keyword(s):

Nutritional Status ◽

Serum Albumin ◽

Serum Albumin Level ◽

Risk Index ◽

Univariate Analysis ◽

Albumin Level ◽

Calorie Intake ◽

Cox Regression Analysis ◽

Nutritional Risk Index ◽

The Impact

Objective To determine the impact of nutritional status on peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in a developing country. Methods 56 patients with end-stage renal disease on CAPD were randomly selected for this study. These patients were assessed for nutritional status and peritonitis episodes. Nutritional parameters were assessed by anthropometry, diet, body mass index (BMI), Nutritional Risk Index (NRI), serum albumin level, and Subjective Global Assessment (SGA). Based on SGA, patients were categorized into either group 1 (malnutrition, n = 31) or group 2 (normal nutritional status, n = 25). Peritonitis was considered the primary outcome and was compared between the two groups. Results Demographic profiles, Kt/V, creatinine clearance, and mean follow-up of the two groups were similar. Number of peritonitis episodes was significantly higher in patients with malnutrition (25/31) compared to patients with normal nutritional status (4/25) ( p = 0.001). Mean peritonitis rate per patient per year was also significantly higher in patients with malnutrition (0.99 ± 1.07) compared to patients with normal nutritional status (0.18 ± 0.42) ( p = 0.007). On univariate analysis, malnutrition based on SGA ( p = 0.009), NRI ( p = 0.02), serum albumin level ( p = 0.005), and calorie intake ( p = 0.006) was a significant predictor of peritonitis. On multivariate Cox regression analysis, only SGA ( p = 0.001, odds ratio 0.08, 95% confidence interval 0.02 – 0.36) was found to be a significant predictor of peritonitis. On general linear model, the observed power of prediction of peritonitis was 0.96 based on SGA. On Kaplan–Meier survival analysis, peritonitis-free survival in patients with normal nutrition (42 months) was significantly higher compared to patients with malnutrition (21 months) based on SGA (log rank p = 0.003). Conclusion We conclude that peritonitis rate is high in patients with malnutrition and that malnutrition indices, especially SGA, can predict the peritonitis rate in CAPD patients.

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P2.01-001 Serum Albumin Level Predicts the Survival Benefit of Chemotherapy in Elderly Advanced NSCLC Patients with Poor Performance Status

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2017.09.1103 ◽

2017 ◽

Vol 12 (11) ◽

pp. S2069

Author(s):

S. Ikeda ◽

H. Yoshioka ◽

S. Ikeo ◽

M. Morita ◽

N. Sone ◽

...

Keyword(s):

Serum Albumin ◽

Survival Benefit ◽

Serum Albumin Level ◽

Advanced Nsclc ◽

Performance Status ◽

Poor Performance ◽

Albumin Level ◽

Poor Performance Status ◽

Nsclc Patients

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Prognostic Significance of Hypoalbuminemia in Patients with Relapsed/Refractory Hodgkin’s Lymphoma (R/R-HL) Undergoing Salvage Autologous Bone Marrow/Peripheral Stem Cell Transplantation (auto-BM/PSCT).

Blood ◽

10.1182/blood.v104.11.5204.5204 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5204-5204

Author(s):

Kiarash Kojouri ◽

Christian El-Khoury ◽

Shubham Pant ◽

Nancy Kohrt ◽

George B. Selby ◽

...

Keyword(s):

Overall Survival ◽

Serum Albumin ◽

Serum Albumin Level ◽

Statistical Significance ◽

Prognostic Significance ◽

Albumin Level ◽

Control Group ◽

Survival Curves ◽

The Difference

Abstract Background: Management of R/R-HL has been disappointing with salvage chemotherapy alone. Although controversy remains over the best time to perform a transplant, auto-BM/PSCT is considered an acceptable salvage therapeutic option for patients (pts) with R/R-HL. Hypoalbuminemia is one of the seven adverse prognostic factors for newly diagnosed pts with HL who receive chemotherapy according to the international prognostic factors project on advanced HL. The prognostic significance of hypoalbuminemia in pts with R/R-HL undergoing salvage auto-BM/PSCT is less clearly defined at the present time. Objective: To evaluate the prognostic significance of hypoalbuminemia in pts with R/R-HL who undergo salvage auto-BM/PSCT. Methods: A retrospective, single-institution study of consecutive pts with R/R-HL who received auto-BM/PSCT at the University of Oklahoma over the last 19 years (1985– 2004) was performed. The serum albumin level during hospital admission for transplant that was closest to, but before, high-dose chemotherapy was recorded and used for this analysis. Hypoalbuminemia was defined as a serum albumin level < 3.5 g/dl. Overall survival (OS) was defined as the time period in months from the day of transplant until death, or the last day of follow-up. Survival curves were estimated according to the Kaplan-Meier method, and were compared between the two groups (control group [≥3.5 g/dl] and low albumin group [< 3.5 g/dl]) with the use of the log-rank test. Median survivals of the two groups were also compared by using Wilcoxon-Mann-Whitney test. One-sided P-value of < 0.05 was considered statistically significant. SAS® sofware (version 8.0; Carry, NC) was used for statistical analysis. Results: 66 patients (40 males, 26 females) were identified, who were 13–69 years old (median 29 years) at the time of transplant. 40 pts (61%) died during follow-up, 4 pts (6%) were lost to follow-up at 15, 27, 58 and 103 months after transplant, and 22 pts (33%) are alive at the time of this analysis (7/30/04), 2–187 months (median 68 months) after transplant. Median survival for the control group (n1=27, 13/27 died) was 78 months (95% CI: 23 - N/A months) and for the low-albumin group (n2=39, 27/39 died) was 22 months (95% CI: 13– 44 months). The difference between overall survival curves (figure) and also the difference between median survivals approached, but did not reach statistical significance (p-values for log-rank and Wilcoxon-Mann-Whitney tests, 0.0632 and 0.0565, respectively). Conclusion: Our results suggest a trend for a worse outcome among pts who undergo salvage auto-BM/PSCT for R/R-HL with low serum albumin (<3.5 g/dl) before transplant. The lack of statistical significance in this analysis is likely related to the relatively limited sample size and the retrospective nature of the study. A larger, prospective analysis evaluating the potential adverse prognostic value of hypoalbuminemia in pts with R/R-HL undergoing auto-BM/PSCT is warranted. Figure Figure

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The efficacy number as a predictor of morbidity and mortality in peritoneal dialysis patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v451184 ◽

1993 ◽

Vol 4 (5) ◽

pp. 1184-1191

Author(s):

M V Rocco ◽

J R Jordan ◽

J M Burkart

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Serum Albumin Level ◽

Strong Predictor ◽

Univariate Analysis ◽

Albumin Level ◽

Dialysis Patients ◽

Plasma Urea ◽

Predicting Outcome ◽

Chronic Ambulatory Peritoneal Dialysis

The efficacy number has been proposed as a predictor of clinical outcome in patients on chronic ambulatory peritoneal dialysis (CAPD). The usefulness of this parameter in a large group of CAPD patients was analyzed. Forty-five patients who have received chronic CAPD therapy for at least 1 yr were included in the study. The efficacy number was compared with outcome as defined by mortality and days of hospitalization. Other demographic and laboratory parameters, including gender; race; presence of diabetes; serum albumin, serum creatinine, and BUN levels; and measures of peritoneal transport, including dialysate-to-plasma creatinine and dialysate-to-plasma urea ratios, were also assessed for their role in predicting outcome. Laboratory values were obtained at the initiation of CAPD and at 12 months after the start of CAPD. By univariate analysis, a low 12-month serum albumin level was the best predictor of mortality (P < 0.005), followed by a high 12-month efficacy number (P < 0.05). After adjusting for age and the presence of diabetes, these two variables remained the best predictors of mortality (P < 0.08 and < 0.09, respectively). A low initial serum albumin level was also a strong predictor of mortality (P < 0.09). By univariate analysis, the best predictor of hospitalization was a low serum albumin level obtained either initially or at 12 months (P < 0.005 for both time periods). After adjusting for age and the presence of diabetes, the 12-month serum albumin level remained a significant predictor of hospitalization (P < 0.03), whereas efficacy number was not a strong predictor (P = 0.27).(ABSTRACT TRUNCATED AT 250 WORDS)

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