Impact of the malnutrition on mortality in Rheumatoid arthritis patients: A cohort study from NHANES 1999–2014

IntroductionAs a composite immunonutritional biomarker, the Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score has shown promise in assessing a patient's overall health status by integrating several routinely collected laboratory indicators. This biomarker has been examined in many different populations of patients and disease states (i.e., cancer), but an integrated, universal rubric using standardized thresholds has not thus far been developed. Pre-existing large population-based databases represent an ideal source to examine the distribution of HALP and the influence of diverse health statuses on this score.MethodsWe conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) between 2017–2020, evaluating 8,245 participants across numerous demographic, socioeconomic, and health-related variables. Univariate and multivariate linear regression analyses assessed the associations between HALP scores and these factors.ResultsOur findings revealed significant associations between HALP scores and various demographic, socioeconomic, and health conditions. The median HALP score among the representative population was 49.0, with varying median scores across different groups and normal reference ranges for males and females. Multivariate regression analysis showed that anemia treatment, age over 65 years, weak/failing kidneys, and cancer were independent risk factors associated with lower HALP scores. Male participants demonstrated higher HALP scores than female participants, and age was inversely related to HALP. Moreover, HALP scores were negatively associated with the number of comorbidities.Conclusion/discussionThis study set out to explore the HALP score from a population-based perspective, uncovering notable associations that offer vital insights into the score's clinical relevance and future applications. By determining a median HALP score of 49.0 and normal reference ranges within our diverse, representative sample, we establish a robust foundation for researchers to refine optimal HALP applications and thresholds. Considering the growing focus on personalized medicine, HALP holds promise as a prognostic tool, enabling clinicians to comprehend their patients' immunonutritional status better and deliver customized care.

Section: Arthritissupporting

confidence: 86%

Evaluating the baseline hemoglobin, albumin, lymphocyte, and platelet (HALP) score in the United States adult population and comorbidities: an analysis of the NHANES

Antar,

Farag,

et al. 2023

“…Khatami ( 35 ) emphasized the critical role of malnutrition in the development of systemic inflammation and associated pathology. Additionally, a cohort study reported a heightened risk of all-cause mortality in RA patients who were malnourished ( 12 ). Therefore, we contended that assessing the prognosis of RA patients should consider both inflammation and malnutrition concurrently.…”

Section: Discussionmentioning

confidence: 99%

“…Excessive protein catabolism evoked by inflammatory cytokines and disuse atrophy due to functional impairment contributes to this progression ( 34 ). Malnutrition further increases the risk of death in RA patients ( 12 ). Thirdly, increased BMI is strongly associated with poor prognosis in patients with RA ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, it is important to underscore that the inflammatory markers utilized in prior studies are somewhat limited in assessing nutritional status and may not comprehensively capture the inflammatory status of patients. Malnutrition is a common occurrence among RA patients and has been closely associated with an increased risk of all-cause mortality in them ( 12 ). There exists a strong correlation between malnutrition and inflammation.…”

Section: Introductionmentioning

confidence: 99%

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Association of advanced lung cancer inflammation index with all-cause and cardiovascular mortality in US patients with rheumatoid arthritis

Ma,

Wu,

Guo

et al. 2024

IntroductionAs a systemic autoimmune disorder, the prognosis of rheumatoid arthritis (RA) is intricately linked to inflammation. This study aimed to investigate the association between the advanced lung cancer inflammation index (ALI), a comprehensive indicator of inflammation combined with nutritional status, and all-cause and cardiovascular mortality among patients diagnosed with RA.MethodsThe 2,305 RA patients from NHANES (2001–2018) included in the analysis were categorized into three groups according to ALI tertiles. Weighted Kaplan–Meier and multivariate COX regression analyses evaluated the relationship between ALI and mortality. The time-dependent characteristic curve (ROC) was used to assess the prediction accuracy of ALI.ResultsDuring a median follow-up of 7.92 years, 591 participants died from all causes, including 197 from cardiovascular diseases. Increased ALI was associated with a decreased probability of death. The full COX model revealed lower all-cause mortality hazard risks in the T2 (HR: 0.67, 95%CI: 0.54–0.83) and T3 (HR: 0.47 95%CI: 0.33–0.67, p for tend <0.001) groups compared to T1, and the risk of cardiovascular mortality was also lower in the groups of T2 (HR: 0.47, 95%CI: 0.31–0.70) and T3 (HR: 0.34, 95%CI: 0.19–0.62, p for trend <0.001). Furthermore, the ROC analysis underscored the strong predictive capability of ALI (AUC for 1-year all-cause and cardiovascular mortality were 0.73 and 0.79, respectively).ConclusionThis cohort study demonstrated the higher accuracy of ALI in predicting mortality in RA patients, highlighting the important clinical value of ALI in risk assessment and prognosis evaluation.

“…Several new laboratory-based nutritional indicators have emerged in recent years, including the Controlling Nutritional Status (CONUT) Score ( 8 ), Advanced Lung Cancer Inflammation Index (ALI) ( 9 ), Geriatric Nutritional Risk Index (GNRI) ( 10 ), Prognostic Nutritional Index (PNI) ( 11 ), Triglycerides (TG) × Total Cholesterol (TC) × Body Weight (BW) Index (TCBI) ( 12 ), and Albumin-to-Globulin Ratio (AGR) ( 13 ). CONUT has been used as an indicator for assessing the risk of mortality in patients with rheumatoid arthritis and type 2 diabetes ( 14 , 15 ). ALI has been used to predict the prognosis of hypertension and heart failure ( 16 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

Association between nutrition-related indicators with the risk of chronic obstructive pulmonary disease and all-cause mortality in the elderly population: evidence from NHANES

Xu,

Yan,

et al. 2024

BackgroundThis study aims to use six nutrition-related indicators to assess the relationship between nutritional status and the risk of COPD as well as the all-cause mortality rate, and to determine the most reliable predictive indicators.MethodsData from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2013 to 2018 were extracted. Nutritional status was evaluated using Controlling nutritional status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), Advanced Lung Cancer Inflammation Index (ALI), Prognostic Nutritional Index (PNI), Triglycerides (TG) × Total Cholesterol (TC) × Body Weight (BW) Index (TCBI), and Albumin-to-Globulin Ratio (AGR) nutritional-related indicators. Multivariate weighted logistic and Cox regression models were employed to assess the correlation between the six nutritional-related indicators and the risk of COPD and as all-cause mortality. The restricted cubic spline tests were applied to explore potential nonlinear relationships, and ROC curves and C-index analyses were conducted to compare the predictive capabilities of different indicators. Stratified analysis and propensity score matching (PSM) to assess the robustness of the results.ResultsIn this study, Lower ALI, lower GNRI, and higher CONUT scores were positively correlated with an increased risk of COPD (OR: 1.77, 95% CI: 1.10–2.84) (OR: 8.66, 95% CI: 2.95–25.5), and (OR: 5.11, 95% CI: 1.72–15.2), respectively. It was found that ALI and GNRI had a non-linear relationship with the risk of COPD. After propensity score matching (PSM), the associations between ALI, GNRI, CONUT scores, and COPD remained consistent. Lower ALI, PNI, and GNRI scores were positively associated with all-cause mortality in COPD patients (HR: 2.41, 95% CI: 1.10–5.27), (HR: 3.76, 95% CI: 1.89–7.48), and (HR: 4.55, 95% CI: 1.30–15.9), respectively, with GNRI displaying a non-linear relationship with all-cause mortality. ROC curve and C-index analyses indicated that ALI had the best predictive ability for both COPD risk and all-cause mortality.ConclusionALI, GNRI, and CONUT scores are correlated with the risk of COPD, while ALI, PNI, and GNRI scores are associated with all-cause mortality in COPD patients. Compared to other nutritional scores, ALI may provide more effective predictive value for both risk and all-cause mortality.