Određivanje nutricionih indeksa i njihova korelacija sa aktivnošću lupus nephritis-a
Sažetak
Uvod/Cilj. Lupus nefritis (LN), kao imuno-inflamacijsko oštećenje bubrega i najteža manifestacija sistemskog eritemskog lupusa (SLE), praćen je i poremećajem nutritivnog statusa bolesnika. Cilj rada bio je da utvrdimo značaj određivanja parametara nutritivnog statusa [indeksa nutritivnog rizika (nutritional risk index – NRI), prognostičkog nutritivnog indeksa (prognostic nutritional index – PNI) i kontrolnog nutritivnog statusa (Control Nutritional Status – CONUT)] i njihovu povezanost sa standardnim parametrima aktivnosti LN. Metode. Kliničko ispitivanje je obuhvatilo grupu od 92 ispitanika: 67 bolesnika sa LN (34 bolesnika je bilo u fazi aktivne bolesti – grupa LNa, a 33 je bilo u fazi remisije – grupa LNr) i 25 zdravih ispitanika u kontrolnoj grupi. Uz standardne laboratorijske parametre i parametre aktivnosti LN, određivani su i izvedeni parametri: PNI = 10 × serumski albumin (g/dL) + 0,005 × ukupni broj limfocita/mm3; NRI = 1,519 × serumski albumin (g/dL) + 41,7 × trenutna težina (kg)/uobičajena telesna težina (definisana kao stabilna telesna težina u poslednjih šest meseci) (kg); CONUT skor = serumski albumin (g/dL) + ukupni broj limfocita/mm3 + ukupan serumski holesterol (mmol/L). Rezultati. Statistički značajna razlika između sve tri grupe zapažena je za PNI (p = 0,001) i za CONUT skor (p = 0,000), dok za NRI nije zabeležena statistički značajna razlika. U grupi LNa nađena je statistički značajna korelacija za PNI u odnosu na albumin, komplement C3 i C4, a statistički značajna negativna korelacija sa nivoom antitela (At) prema dvolančanoj DNK (double stranded DNA – dsDNA). Za NRI je nađena značajna korelacija samo sa proteinurijom, u grupi LNa. CONUT je pokazao značajnu korelaciju sa najvećim brojem parametara za aktivnost bolesti: negativnu korelaciju sa albuminom i komplementom C3 (p = 0,000), a pozitivnu korelaciju sa anti-dsDNA At (p = 0,002), sa indeksom Systemic Lupus Erythematosus Disease Activity Index/renal - SLEDAI/r i sa proteinurijom/24hrs (p = 0,000). Zaključak. Nutritivni indeksi CONUT i PNI pokazali su statistički značajnu razliku izmedju grupa LNa i LNr. Korelacija pomenutih indeksa sa standardnim parametrima aktivne bolesti bila je značajna za većinu parametara u grupi LNa bolesnika.
Reference
Wu H, Zhou C, Kong W, Zhang Y, Pan D. Prognostic nutrition index is associated with the all-cause mortality in sepsis patients: A retrospective cohort study. J Clin Lab Anal 2022; 36(4): e24297.
Xie Y, He C, Wang W. Prognostic nutritional index: A potential biomarker for predicting the prognosis of decompensated liver cirrhosis. Front Nutr 2023; 9: 1092059.
Huang X, Hu H, Zhang W, Shao Z. Prognostic value of prognostic nutritional index and systemic immune-inflammation index in patients with osteosarcoma. J Cell Physiol 2019; 234(10): 18408–14.
Zhang S, Wang H, Chen S, Cai S, Zhou S, Wang C, et al. Prognostic nutritional index and prognosis of patients with coronary artery disease: A systematic review and meta-analysis. Front Nutr 2023; 10: 1114053.
Wada H, Dohi T, Miyauchi K, Jun S, Endo H, Doi S, et al. Relationship between the prognostic nutritional index and long-term clinical outcomes in patients with stable coronary artery disease. J Cardiol 2018; 72(2): 155–61.
Dupont R, Longué M, Galinier A, Cinq Frais C, Ingueneau C, Astudillo L, et al. Impact of micronutrient deficiency & malnutrition in systemic sclerosis: Cohort study and literature review. Autoimmun Rev 2018; 17(11): 1081–89.
Corallo C, Fioravanti A, Tenti S, Pecetti G, Nuti R, Giordano N. Sarcopenia in systemic sclerosis: the impact of nutritional, clinical, and laboratory features. Rheumatol Int 2019; 39(10): 1767–75.
Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, et al. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis 2020; 76(3 Suppl 1): S1–107. Erratum in: Am J Kidney Dis 2021; 77(2): 308.
Hanly JG, O'Keeffe AG, Su L, Urowitz MB, Romero-Diaz J, Gordon C, et al. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford) 2016; 55(2): 252–62.
Borges MC, dos Santos Fde M, Telles RW, Lanna CC, Correia MI. Nutritional status and food intake in patients with systemic lupus erythematosus. Nutrition 2012; 28(11–12): 1098–103.
Pesqueda-Cendejas K, Rivera-Escoto M, Meza-Meza MR, Campos-López B, Parra-Rojas I, Montoya-Buelna M, et al. Nutritional Approaches to Modulate Cardiovascular Disease Risk in Systemic Lupus Erythematosus: A Literature Review. Nutrients 2023; 15(4): 1036.
Klack K, Bonfa E, Borba Neto EF. Diet and nutritional aspects in systemic lupus erythematosus. Rev Bras Reumatol 2012; 52(3): 384–408. (English, Portuguese)
Behiry ME, Salem MR, Alnaggar AR. Assessment of nutritional status and disease activity level in Systemic Lupus Erythematosus patients at a tertiary care hospital. Rev Colomb Reumatol 2019; 26(2): 97–104.
Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004; 17(6): 432–7.
Idborg H, Eketjäll S, Pettersson S, Gustafsson JT, Zickert A, Kvarnström M, et al. TNF-α and plasma albumin as biomarkers of disease activity in systemic lupus erythematosus. Lupus Sci Med 2018; 5(1): e000260.
Sobhy N, Niazy MH, Kamal A. Lymphopenia in systemic lupus erythematosus patients: Is it more than a laboratory finding? Egypt Rheumatol 2020; 42(1): 23–6.
Kim SY, Yu M, Morin EE, Kang J, Kaplan MJ, Schwendeman A. High-Density Lipoprotein in Lupus: Disease Biomarkers and Potential Therapeutic Strategy. Arthritis Rheumatol 2020; 72(1): 20–30.
Correa-Rodríguez M, Pocovi-Gerardino G, Callejas-Rubio JL, Fernández RR, Martín-Amada M, Cruz-Caparros MG, et al. The Prognostic Nutritional Index and Nutritional Risk Index Are Associated with Disease Activity in Patients with Systemic Lupus Erythematosus. Nutrients 2019; 11(3): 638.
Ahn SS, Yoo J, Jung SM, Song JJ, Park YB, Lee SW. Comparison of the Clinical Implications among Five Different Nutritional Indices in Patients with Lupus Nephritis. Nutrients 2019; 11(7): 1456.
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40(9): 1725.
Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol 2019; 71(9): 1400–12.
Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002; 29(2): 288–91.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150(9): 604–12. Erratum in: Ann Intern Med 2011; 155(6): 408.
Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, González P, González B, Mancha A, et al. CONUT: A tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 2005; 20(1): 38–45.
Ahn SS, Jung SM, Song JJ, Park YB, Lee SW. Prognostic nutritional index is correlated with disease activity in patients with systemic lupus erythematosus. Lupus 2018; 27(10): 1697–705.
Rabrenović V, Petrović M, Rabrenović M, Pilcević D, Rančić N. The significance of biomarkers of inflammation in predicting the activity of lupus nephritis. J Med Biochem 2024; 43: 116–25.
Vilá LM, Alarcón GS, McGwin G Jr, Bastian HM, Fessler BJ, Reveille JD. Systemic lupus erythematosus in a multiethnic US cohort, XXXVII: association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual. Arthritis Rheum 2006; 55(5): 799–806.
Schanberg LE, Sandborg C, Barnhart HX, Ardoin SP, Yow E, Evans GW, et al. Premature atherosclerosis in pediatric systemic lupus erythematosus: risk factors for increased carotid intima-media thickness in the atherosclerosis prevention in pediatric lupus erythematosus cohort. Arthritis Rheum 2009; 60(5): 1496–507.
Thomas PE, Jensen BW, Sørensen KK, Jacobsen S, Aarestrup J, Baker JL. Early life body size, growth and risks of systemic lupus erythematosus - A large Danish observational cohort study. Semin Arthritis Rheum 2020; 50(6): 1507–12.