title: Predictive Value of Glycated Hemoglobin and Body Mass Index for Pretreatment Neuropathy in Patients With Multiple Myeloma.
abstract: BACKGROUND
  Peripheral neuropathy (PN) is detected in up to 62% patients with multiple myeloma (MM) at diagnosis. No specific risk factor for pretreatment neuropathy has been identified.
  
  
  METHODS
  We evaluated 29 sequential patients with MM attending our tertiary care center for peripheral neuropathy at diagnosis using symptoms, clinical examination, and nerve conduction studies (NCSs). Total Neuropathy Score, reduced (TNSr) and Total Neuropathy Score, clinical (TNSc) were calculated, and a score of ≥ 2 in each scale was considered diagnostic of PN. The study was approved by our institutional review board.
  
  
  RESULTS
  We found that 51.7% (n = 15) and 17.2% (n = 5) of patients had pretreatment neuropathy by TNSr and TNSc scales, respectively. Higher glycated hemoglobin (HbA1C) (P = .022), higher body mass index (BMI) (P = .008), higher serum creatinine levels (P = .023), and higher blood urea levels (P = .006) were associated with neuropathy by TNSr in univariate analysis. Higher blood urea levels (P = .023), higher serum creatinine levels (P = .003), and higher serum β2-microglobulin levels (P = .013) were associated with neuropathy by TNSc in univariate analysis. Higher HbA1c levels (P = .036; odds ratio [OR], 9.46) and BMI (P = .028; OR, 1.78) were associated with neuropathy by TNSr on binomial logistic regression analysis. Cutoffs of 5.6% (sensitivity, 60%; specificity, 71.4%) and 23.7 kg/m(2) (sensitivity, 80%; specificity, 71.4%) were obtained for HbA1c (area under the curve [AUC], 0.75) and BMI (AUC, 0.79), respectively, on receiver operating characteristic (ROC) curve analysis to predict neuropathy. The combination of HbA1c ≥ 5.6% and BMI ≥ 23.7 kg/m(2) had higher odds of neuropathy by TNSr (OR, 27.0; 95% confidence interval [CI], 2.0-368.4) when compared with either factor alone.
  
  
  CONCLUSIONS
  Use of TNSr, which incorporates electrophysiological abnormalities in addition to clinical manifestations, improves the detection rate of neuropathy. We found that high HbA1c and high BMI together are risk factors for neuropathy at diagnosis in patients with MM.
authors.affiliation: Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Arjun
authors.initials: A
authors.lastname: Lakshman
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Modi
authors.affiliation: Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: drgp04@gmail.com.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Prakash
authors.affiliation: Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Malhotra
authors.affiliation: Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Alka
authors.initials: A
authors.lastname: Khadwal
authors.affiliation: Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Suri
authors.affiliation: Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pinaki
authors.initials: P
authors.lastname: Dutta
authors.affiliation: Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Jain
authors.affiliation: Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Savita
authors.initials: S
authors.lastname: Kumari
authors.affiliation: Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Neelam
authors.initials: N
authors.lastname: Varma
authors.affiliation: Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Subhash
authors.initials: S
authors.lastname: Varma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000378:metabolism; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin
keywords: Body mass index; Glycated hemoglobin; Multiple myeloma; Peripheral neuropathy; Predictors