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Prior-Sánchez I, Herrera-Martínez AD, Zarco-Martín MT, Fernández-Jiménez R, Gonzalo-Marín M, Muñoz-Garach A, Vilchez-López FJ, Cayón-Blanco M, Villarrubia-Pozo A, Muñoz-Jiménez C, Zarco-Rodríguez FP, Rabat-Restrepo JM, Luengo-Pérez LM, Boughanem H, Martínez-Ramírez MJ, García-Almeida JM. Prognostic value of bioelectrical impedance analysis in head and neck cancer patients undergoing radiotherapy: a VALOR® study. Front Nutr 2024; 11:1335052. [PMID: 38463940 PMCID: PMC10921554 DOI: 10.3389/fnut.2024.1335052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Bioelectrical impedance analysis (BIA) serves as a method to estimate body composition. Parameters such as phase angle (PA), standardized phase angle (SPA), body mass cell (BCM), BCM index (BCMI), and fat-free mass (FFM) might significantly impact the prognosis of head and neck cancer (HNC) patients. The present study aimed to investigate whether bioelectrical parameters can be used to predict survival in the HNC population and establish the optimal cutoff points for predictive accuracy. Methods A multicenter observational study was performed across 12 tertiary hospitals in Andalusia (a region from the south of Spain). A total of 494 patients diagnosed with HNC between 2020 and 2022 at different stages were included in this study, with a minimum follow-up period of 12 months. The BIA assessment was carried out during the first 2 weeks of radical radiotherapy treatment with chemotherapy or other systemic treatments. A multivariate logistic regression analysis of overall survival, complications, hospital admission, and palliative care and its relationship with BIA nutritional assessment was performed. Results Significant prognostic factors identified in the multivariable analysis encompassed phase angle (PA), standardized phase angle (SPA), body cell mass (BCM), and BCM index (BCMI). Lower PA and BCM values were significantly associated with adverse clinical outcomes. A BCM threshold above 17 kg/m2 was the most significant predictor for predicting survival within the overall HNC population. The PA values of <5.1° in male and <4.8° in female patients showed the best predictive potential for mortality. Increased PA (as a continuous variable) demonstrated a significantly reduced risk for mortality (OR, 0.64; 95% CI, 0.43-0.94; p < 0.05) and a decreased likelihood of hospital admission (OR, 0.75; 95% CI, 0.52-1.07; p < 0.05). Higher BCM correlated with a lower risk of mortality (OR, 0.88; 95% CI, 0.80-0.96; p < 0.01) and a diminished probability of hospital admission (OR, 0.91; 95% CI, 0.83-0.99; p < 0.05). Conclusion BIA is a crucial tool in the nutritional assessment of HNC patients. BCM and PA are the main bioelectrical parameters used to predict clinical outcomes in this population. Future studies are needed to validate BIA variables in a large cohort to ensure whether early intensification of nutritional treatment would improve survival.
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Affiliation(s)
| | - Aura Dulcinea Herrera-Martínez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Cordoba, Spain
| | - María Teresa Zarco-Martín
- Department of Endocrinology and Nutrition, San Cecilio University Hospital, Granada, Spain
- Granada Biosanitary Research Institute (Ibs. Granada), Granada, Spain
| | - Rocío Fernández-Jiménez
- Malaga Biomedical Research Institute and BIONAND Platform, Endocrinology and Nutrition Department, Hospital Virgen de la Victoria de Malaga, Malaga, Spain
- Department of Endocrinology and Nutrition, Quironsalud Malaga Hospital, Malaga, Spain
- Department of Medicine and Dermatology, Malaga University, Malaga, Spain
| | - Montserrat Gonzalo-Marín
- Endocrinology and Nutrition Department, Malaga Regional University Hospital, Malaga, Spain
- Malaga Biomedical Research Institute and BIONAND Platform, Malaga, Spain
| | - Araceli Muñoz-Garach
- Granada Biosanitary Research Institute (Ibs. Granada), Granada, Spain
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, Granada, Spain
- Network Biomedical Research Center Physiopathology of Obesity and Nutrition (CiberOBN), Carlos III Health Institute, Madrid, Spain
| | - Francisco Javier Vilchez-López
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz, Cadiz, Spain
| | - Manuel Cayón-Blanco
- Biomedical Research and Innovation Institute of Cadiz, Cadiz, Spain
- Endocrinology and Nutrition Department, Hospital Universitario de Jerez de la Frontera, Cadiz, Spain
| | - Ana Villarrubia-Pozo
- Department of Endocrinology and Nutrition, Seville Institute of Biomedicine (IBIS), Virgen del Rocio University Hospital, Seville, Spain
| | - Concepción Muñoz-Jiménez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Cordoba, Spain
| | | | | | - Luis Miguel Luengo-Pérez
- Department of Endocrinology and Nutrition, Badajoz University Hospital, Seville, Spain
- Department of Biomedical Sciences, Universidad de Extremadura, Badajoz, Spain
| | - Hatim Boughanem
- Malaga Biomedical Research Institute and BIONAND Platform, Endocrinology and Nutrition Department, Hospital Virgen de la Victoria de Malaga, Malaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute, Madrid, Spain
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Cordoba, Spain
| | | | - Jose Manuel García-Almeida
- Malaga Biomedical Research Institute and BIONAND Platform, Endocrinology and Nutrition Department, Hospital Virgen de la Victoria de Malaga, Malaga, Spain
- Department of Endocrinology and Nutrition, Quironsalud Malaga Hospital, Malaga, Spain
- Department of Medicine and Dermatology, Malaga University, Malaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute, Madrid, Spain
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Fernández-Jiménez R, García-Rey S, Roque-Cuéllar MC, Fernández-Soto ML, García-Olivares M, Novo-Rodríguez M, González-Pacheco M, Prior-Sánchez I, Carmona-Llanos A, Muñoz-Jiménez C, Zarco-Rodríguez FP, Miguel-Luengo L, Boughanem H, García-Luna PP, García-Almeida JM. Ultrasound Muscle Evaluation for Predicting the Prognosis of Patients with Head and Neck Cancer: A Large-Scale and Multicenter Prospective Study. Nutrients 2024; 16:387. [PMID: 38337671 PMCID: PMC10857428 DOI: 10.3390/nu16030387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Head and neck cancer (HNC) is a prevalent and aggressive form of cancer with high mortality rates and significant implications for nutritional status. Accurate assessment of malnutrition in patients with HNC is crucial for optimizing treatment outcomes and improving survival rates. This study aimed to evaluate the use of ultrasound techniques for predicting nutritional status, malnutrition, and cancer outcomes in patients with HNC. A total of 494 patients with HNC were included in this cross-sectional observational study. Various tools and body composition measurements, including muscle mass and adipose tissue ultrasound evaluations, were implemented. Using regression models, we mainly found that high levels of RF-CSA (rectus femoris cross-sectional area) were associated with a decreased risk of malnutrition (as defined with GLIM criteria (OR = 0.81, 95% CI: 0.68-0.98); as defined with PG-SGA (OR = 0.78, 95% CI: 0.62-0.98)) and sarcopenia (OR = 0.64, 95% CI: 0.49-0.82) after being adjusted for age, sex, and BMI. To predict the importance of muscle mass ultrasound variables on the risk of mortality, a nomogram, a random forest, and decision tree models were conducted. RF-CSA was the most important variable under the random forest model. The obtained C-index for the nomogram was 0.704, and the Brier score was 16.8. With an RF-CSA < 2.7 (AUC of 0.653 (0.59-0.77)) as a split, the decision tree model classified up to 68% of patients as possessing a high probability of survival. According to the cut-off value of 2.7 cm2, patients with a low RF-CSA value lower than 2.7 cm2 had worse survival rates (p < 0.001). The findings of this study highlight the importance of implementing ultrasound tools, for accurate diagnoses and monitoring of malnutrition in patients with HNC. Adipose tissue ultrasound measurements were only weakly associated with malnutrition and not with sarcopenia, indicating that muscle mass is a more important indicator of overall health and nutritional status. These results have the potential to improve survival rates and quality of life by enabling early intervention and personalized nutritional management.
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Affiliation(s)
- Rocío Fernández-Jiménez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga Biomedical Research Institute and BIONAND Platform (IBIMA), 29010 Malaga, Spain; (R.F.-J.); (J.M.G.-A.)
- Department of Endocrinology and Nutrition, QuironSalud Malaga Hospital, 29004 Malaga, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
| | - Silvia García-Rey
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Instituto de Biomedicina de Sevilla (IBIS), 41013 Seville, Spain; (S.G.-R.); (M.C.R.-C.); (P.P.G.-L.)
| | - María Carmen Roque-Cuéllar
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Instituto de Biomedicina de Sevilla (IBIS), 41013 Seville, Spain; (S.G.-R.); (M.C.R.-C.); (P.P.G.-L.)
| | - María Luisa Fernández-Soto
- Endocrinology and Nutrition Clinical Management Unit, University Hospital San Cecilio, 18012 Granada, Spain;
- Biosanitary Institute of Granada, Medicine Department, Faculty of Medicine of Granada, University of Granada, 18010 Granada, Spain
| | - María García-Olivares
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
- Department of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital, 29007 Malaga, Spain
| | - María Novo-Rodríguez
- Department of Endocrinology and Nutrition, FIBAO (Fundación para la Investigación Biosanitaria de Andalucia Oriental), Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | - María González-Pacheco
- Department of Endocrinology and Nutrition, Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Puerta del Mar University Hospital, 11009 Cadiz, Spain;
| | | | - Alba Carmona-Llanos
- Department of Endocrinology and Nutrition, Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Jerez de la Frontera University Hospital, 11407 Cadiz, Spain;
| | - Concepción Muñoz-Jiménez
- Department of Endocrinology and Nutrition, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, 14011 Cordoba, Spain;
| | | | - Luis Miguel-Luengo
- Department of Endocrinology and Nutrition, Badajoz University Hospital, 06080 Badajoz, Spain;
- Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad de Extremadura, 06006 Badajoz, Spain
| | - Hatim Boughanem
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga Biomedical Research Institute and BIONAND Platform (IBIMA), 29010 Malaga, Spain; (R.F.-J.); (J.M.G.-A.)
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, 14004 Cordoba, Spain
| | - Pedro Pablo García-Luna
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Instituto de Biomedicina de Sevilla (IBIS), 41013 Seville, Spain; (S.G.-R.); (M.C.R.-C.); (P.P.G.-L.)
| | - José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga Biomedical Research Institute and BIONAND Platform (IBIMA), 29010 Malaga, Spain; (R.F.-J.); (J.M.G.-A.)
- Department of Endocrinology and Nutrition, QuironSalud Malaga Hospital, 29004 Malaga, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
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López Zúñiga MÁ, Moreno-Moral A, Ocaña-Granados A, Padilla-Moreno FA, Castillo-Fernández AM, Guillamón-Fernández D, Ramírez-Sánchez C, Sanchez-Palop M, Martínez-Colmenero J, Pimentel-Villar MA, Blázquez-Roselló S, Moreno-Sánchez JJ, López-Vílchez M, Prior-Sánchez I, Jódar-Moreno R, López Ruz MÁ. High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response. PLoS One 2021; 16:e0243964. [PMID: 33507958 PMCID: PMC7842890 DOI: 10.1371/journal.pone.0243964] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Test whether high dose corticosteroid pulse therapy (HDCPT) with either methylprednisolone or dexamethasone is associated with increased survival in COVID-19 patients at risk of hyper-inflammatory response. Provide some initial diagnostic criteria using laboratory markers to stratify these patients. METHODS This is a prospective observational study, 318 met the inclusion criteria. 64 patients (20.1%) were treated with HDCPT by using at least 1.5mg/kg/24h of methylprednisolone or dexamethasone equivalent. A multivariate Cox regression (controlling for co-morbidities and other therapies) was carried out to determine whether HDCPT (among other interventions) was associated with decreased mortality. We also carried out a 30-day time course analysis of laboratory markers between survivors and non-survivors, to identify potential markers for patient stratification. RESULTS HDCPT showed a statistically significant decrease in mortality (HR = 0.087 [95% CI 0.021-0.36]; P < 0.001). 30-day time course analysis of laboratory marker tests showed marked differences in pro-inflammatory markers between survivors and non-survivors. As diagnostic criteria to define the patients at risk of developing a COVID-19 hyper-inflammatory response, we propose the following parameters (IL-6 > = 40 pg/ml, and/or two of the following: C-reactive protein > = 100 mg/L, D-dimer > = 1000 ng/ml, ferritin > = 500 ng/ml and lactate dehydrogenase > = 300 U/L). CONCLUSIONS HDCPT can be an effective intervention to increase COVID-19 survival rates in patients at risk of developing a COVID-19 hyper-inflammatory response, laboratory marker tests can be used to stratify these patients who should be given HDCPT. This study is not a randomized clinical trial (RCT). Future RCTs should be carried out to confirm the efficacy of HDCPT to increase the survival rates of COVID-19.
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Affiliation(s)
- Miguel Ángel López Zúñiga
- Infectious Diseases Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Grupo de investigación CTS 990: GEAPACECP, Universidad de Jaén, Jaén, Spain
| | | | | | | | | | | | | | | | - Justo Martínez-Colmenero
- Grupo de investigación CTS 990: GEAPACECP, Universidad de Jaén, Jaén, Spain
- Internal Medicine Service, Complejo Hospitalario de Jaén, Jaén, Spain
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Prior-Sánchez I, Barrera Martín A, Moreno Ortega E, Vallejo Casas JA, Gálvez Moreno MÁ. Is a second recombinant human thyrotropin stimulation test useful? The value of postsurgical undetectable stimulated thyroglobulin level at the time of remnant ablation on clinical outcome. Clin Endocrinol (Oxf) 2017; 86:97-107. [PMID: 27327536 DOI: 10.1111/cen.13140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The management of patients with differentiated thyroid cancer (DTC) has changed in recent years, and monitoring depends on the risk of persistent/recurrent disease. The objective was to assess the prognostic value of a single stimulated thyroglobulin (Tg) measured at the time of the first radioiodine therapy (Stim-Tg1), and the utility of a second stimulated Tg measurement performed 6-12 months later (Stim-Tg2). We also examined the role of neck ultrasound (US) in the early diagnosis of recurrence. DESIGN This was a retrospective observational cohort study conducted in a tertiary referral hospital. Of 213 evaluated patients with DTC, 169 were finally included. METHODS Measurement of Stim-Tg1, Stim-Tg2 and neck US. RESULTS Stim-Tg1 was undetectable in 71 of 169 patients (42%). All of them (71/71) continued to have negative Stim-Tg2. Seventy of 71 had an excellent response to the first treatment. Sixty-eight of 71 had no evidence of disease after an average follow-up of 7·2 years. In patients with detectable Stim-Tg1 (98/169; 58%), Stim-Tg2 became negative in 40. The negative predictive value (NPV) of Stim-Tg1 was 0·96. The optimal Stim-Tg1 cut-off level for identifying persistence was 3·65 ng/ml. Recurrence was detected in 14 patients. Neck US was useful for identifying local recurrence (13/14; 92·85%). CONCLUSIONS Stim-Tg1 is a reliable marker with a high NPV. A second stimulation test should be avoided in patients with negative Stim-Tg1. In patients with biochemical persistence, Stim-Tg2 is useful for confirming/ruling out final status. Neck US plays a valuable role in the early diagnosis of recurrence.
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Affiliation(s)
| | - Ana Barrera Martín
- Department of Endocrinology and Metabolism, Reina Sofia University Hospital, Córdoba, Spain
| | | | | | - María Á Gálvez Moreno
- Department of Endocrinology and Metabolism, Reina Sofia University Hospital, Córdoba, Spain
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Prior-Sánchez I, Herrera-Martínez AD, Tenorio Jiménez C, Molina Puerta MJ, Calañas Continente AJ, Manzano García G, Gálvez Moreno MÁ. [Percutaneous endoscopic gastrostomy in a myotrophic lateral sclerosis. Experience in a district general hospital]. NUTR HOSP 2014; 30:1289-94. [PMID: 25433110 DOI: 10.3305/nh.2014.30.6.7808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) is a degenerative disorder that affects the pyramidal tract, producing progressive motor dysfunctions leading to paralysis. These patients can present with dysphagia, requiring nutritional support with a nasogastric tube or Percutaneous Endoscopic Gastrostomy (PEG). PEG is associated with increased survival rates. However, the timing of PEG placement remains a significant issue for clinicians. OBJECTIVE To analyse the characteristics of ALS patients at the moment of PEG placement and their progression. METHODS AND MATERIALS Descriptive retrospective study including patients diagnosed with ALS and PEG who were assessed during the 2005-2014 period in our hospital. Nutritional parameters and respiratory function were assessed for all patients, as well as their progression. The data was analysed using SPSS15. RESULTS 37 patients were included (56.8% men, 43.2% women) with an average age of 60 at diagnosis, and an average age of 63.1 at PEG placement. 48.6% started with spinal affection and 51.4%, with bulbar affection. 43.2% of the patients received oral nutritional supplements prior to PEG placement for a mean period of 11.3 months. The mean forced vital capacity at diagnosis was 65.45±13.67%, with a negative progression up to 39.47±14.69% at the moment of PEG placement. 86.5% of patients required non-invasive positive-pressure ventilation. 86.5% presented with dysphagia, 64.9% with weight loss > 5-10% from their usual weight, 8.1% with low Body Mass Index, 27% with malnutrition and 73% with aworsened breathing function; therefore, 100% met the criteria for PEG placement according to our protocol. The period on enteral feeding was extended for 10.1 months with a mortality of 50% during the first 6 months from PEG placement. CONCLUSIONS There is evidence of a 3-year delay between diagnosis and PEG placement, with a survival rate of 50% at 6 months from PEG insertion. Further studies are required to establish whether an earlier placement might increase survival rates.
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