Research and Development Unit, Östersund Hospital, Östersund, Sweden.
Department of Radiation sciences, Unit of Clinical research-Östersund, Umeå University, Umeå, Sweden.
PLoS One. 2018 Mar 13;13(3):e0193693. doi: 10.1371/journal.pone.0193693. eCollection 2018.
Amongst patients with incurable cancer approaching death, cachexia is common and associated with adverse outcomes. The term cachexia lacks a universally accepted definition and there is no consensus regarding which variables are to be measured. Furthermore, an elevated C-reactive protein is a common clinical challenge in this patient group. This study aims to add to the ongoing discussion regarding the definition of cancer cachexia and to study the role of C-reactive protein and s-albumin in this context.
A 1-year cohort, consisting of 155 cancer patients enrolled in a specialized palliative home care team in the city of Östersund, Sweden, that were deceased during the year of 2015 was studied. Laboratory measures were studied within 0-30 and 31-60 days prior to death. C-reactive protein >10 mg/L and coinciding s-albumin <30 g/L was referred to as "laboratory cachexia". Also, the number of days from the first found "laboratory cachexia" until death was noted.
The prevalence of "laboratory cachexia" was 85% 0-30 days prior to death compared to 66% 31-60 days prior to death (p<0.01). The majority of patients (75%) had an onset of "laboratory cachexia" within 0-120 days prior to death, with a median of 47 days. The median values for C-reactive protein and s-albumin within 0-30 days prior to death were 84mg/L and 23g/L respectively.
Could markedly deranged values of C-reactive protein and s-albumin, such as found in this study, signal a relatively short remaining survival time in patients with incurable cancer and no clinical signs of ongoing infection? The role of "laboratory cachexia" in this context as well as the cut off values for the laboratory measures included may be further discussed.
在接近死亡的不治之症患者中，恶病质很常见，并与不良结局相关。恶病质一词缺乏普遍接受的定义，也没有关于应测量哪些变量的共识。此外，C 反应蛋白升高是该患者群体的常见临床挑战。本研究旨在进一步讨论癌症恶病质的定义，并研究 C 反应蛋白和 s 白蛋白在此背景下的作用。
研究了一个为期 1 年的队列，包括 2015 年在瑞典Östersund市专门的姑息治疗家庭护理团队中登记的 155 名癌症患者，这些患者在这一年中死亡。在死亡前 0-30 天和 31-60 天内研究了实验室测量值。C 反应蛋白>10mg/L 且同时 s 白蛋白<30g/L 被称为“实验室恶病质”。此外，还记录了从首次发现“实验室恶病质”到死亡的天数。
与死亡前 31-60 天相比，死亡前 0-30 天“实验室恶病质”的患病率为 85%（p<0.01）。大多数患者（75%）在死亡前 0-120 天内出现“实验室恶病质”，中位时间为 47 天。死亡前 0-30 天内 C 反应蛋白和 s 白蛋白的中位数分别为 84mg/L 和 23g/L。
在没有持续感染的临床迹象的情况下，C 反应蛋白和 s 白蛋白等值明显异常，如本研究中所示，是否预示着无法治愈的癌症患者的剩余生存时间相对较短？可以进一步讨论这种情况下“实验室恶病质”的作用以及所包括的实验室测量的截止值。
