title: Evaluation of the nutritional and inflammatory status in cancer patients for the risk assessment of severe haematological toxicity following chemotherapy.
abstract: BACKGROUND
  The toxicity outcome of cancer patients receiving chemotherapy is difficult to predict. In this study the influence of malnutrition and inflammation on acute haematological toxicity was investigated.
  
  
  METHODS
  Between January 1999 and January 2000, 48 consecutive cancer patients experienced severe haematological toxicity (SHT), either neutropenic fever or severe thrombocytopenia, following various chemotherapy regimens. Their baseline characteristics were compared with those of 59 control patients. Previous chemotherapy regimens, type of chemotherapy, performance status (PS), calculated creatinine clearance, bilirubin, C-reactive protein (1), alpha-1 acid glycoprotein (2), albumin (3), pre-albumin (4) and the nutritional and inflammatory status (NIS) ratio [NIS = (1 x 2)/(3 x 4)] were studied. Statistical analysis was carried out using either a t-test or a chi-square test. A receiver operating characteristic (ROC) curve determined the cut-off value for NIS.
  
  
  RESULTS
  Patients experiencing SHT had a higher PS (P <0.001), inflammatory serum protein levels (P <0.001) and NIS ratio (P <0.0001), but lower haemoglobin (P <0.05) and serum-albumin levels (P <0.0001). Using a cut-off of 0 or 1 for PS and 1 for NIS, sensitivity was 98%, 43% and 89%; specificity was 38%, 90% and 66%, respectively. In 37 patients treated with topotecan as single agent, the determinants for SHT were PS (P <0.0001) and NIS (P <0.0001).
  
  
  CONCLUSIONS
  Altered nutritional and inflammatory status correlates with increased risk of severe haematological toxicity following anticancer chemotherapy.
authors.affiliation: Groupe Hospitalier Cochin, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Alexandre
authors.forename: M
authors.initials: M
authors.lastname: Gross-Goupil
authors.forename: B
authors.initials: B
authors.lastname: Falissard
authors.forename: M-L
authors.initials: ML
authors.lastname: Nguyen
authors.forename: J-M
authors.initials: JM
authors.lastname: Gornet
authors.forename: J-L
authors.initials: JL
authors.lastname: Misset
authors.forename: F
authors.initials: F
authors.lastname: Goldwasser
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000378:metabolism; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001663:Bilirubin / Q000378:metabolism; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced*; D009748:Nutrition Disorders / Q000097:blood* / Q000175:diagnosis; D009961:Orosomucoid / Q000378:metabolism; D011228:Prealbumin / Q000378:metabolism; D011379:Prognosis; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D000418:Albumins; D000970:Antineoplastic Agents; D015415:Biomarkers; D009961:Orosomucoid; D011228:Prealbumin; D002097:C-Reactive Protein; D003404:Creatinine; D001663:Bilirubin