Hypoalbuminemia predicts inferior outcome in patients with AIDS-related lymphoma

Demographic and clinical characteristics in ARL patients enrolled

A total of 86 patients with ARL were enrolled, with a median follow-up of 34 months. DLBCL is the most frequent subtype in ARL (95.3%). There were 54 (62.8%) ARL patients dead at the end of follow-up, and these patients tended to present with higher IPI score (p = 0.027) and lower CD4 + T cells (p = 0.046), as shown in Table 1. There were no significant differences in the clinical features of sex, BMI, CD8 + T cells, CD4/CD8 ratio, ESR, platelet count, LDH, serum ALB, and ECOG PS.

Table 1 The demographics and clinical characteristics of patients enrolledPrognostic factors associated with patients with ARL

Among ARL patients enrolled, the OS and 2-year PFS were 37.5% and 35.4%, respectively (Fig. 1). To further evaluate risk factors correlated with prognosis, univariable and multivariable analysis were conducted. Results from multivariate analysis demonstrated that older age (HR = 1.034, p = 0.041) and lower ALB level (HR = 0.910, p = 0.038) were independent prognostic factors associated with OS in ARL population (Table 2).

Fig. 1figure 1

Kaplan–Meier survival curves for A overall survival (37.5%) and B 2-year progression-free survival (35.4%) in 86 AIDS-related lymphoma patients. Abbreviation: AIDS: Acquired immunodeficiency syndrome

Table 2 Factors associated with overall survival in AIDS-related lymphoma patients

We then adopted multivariable analysis to evaluate factors correlated with 2-year PFS in ARL patients enrolled. Of note, as an unfavorable factor, age (HR = 1.035, p = 0.041) retained its statistical significance for 2-year PFS in patients with ARL (Table 3).

Table 3 Factors associated with 2-year progress-free survival in patients with AIDS-related lymphomaHypoalbuminemia predicted worse prognosis in ARL

To further investigate ALB as a novel biomarker for prognosis in ARL, we divided patients into ALB > 35.0 g/L and ALB ≤ 35.0 g/L groups at the time of diagnosis. A Kaplan–Meier survival analysis was conducted by using data from all patients enrolled in the study. Similarly, the patients with low ALB level had remarkably worse outcomes in terms of OS (p = 0.028) and 2-year PFS (p = 0.010), when compared with those with high ALB level, as depicted in Fig. 2.

Fig. 2figure 2

Kaplan–Meier survival curves of the serum ALB stratifications for overall survival (A) and 2-year progression-free survival (B) in AIDS-related lymphoma patients (n = 86). Abbreviation: ALB, albumin; AIDS: Acquired immunodeficiency syndrome

Relationship between serum album level and clinical variables

We next explored the relationship between serum album level and other clinical variables in patients with ARL by Pearson's correlation analysis. A strong correlation between serum ALB and age (r = 0.263, p = 0.016), CD4 + T cells (r = 0.250, p = 0.025), ESR (r = -0.429, p < 0.001), LDH (r = -0.305, p = 0.005), RDW-SD (red cell distribution width standard deviation, r = -0.244, p = 0.029), and BMI (r = 0.237, p = 0.039) were validated (Fig. 3).

Fig. 3figure 3

Correlation of serum ALB with other clinical variables. ALB level by age (A), CD4 + T cells (B), ESR (C), LDH (D), RDW-SD (E), and BMI (F). Abbreviations: ALB, albumin; CD4: Cluster of differentiation 4; ESR, erythrocyte sedimentation rate; LDH, lactate dehydrogenase; RDW-SD, red cell distribution width standard deviation; BMI, body max index

A total of 33.3%, 45.2%, and 84.6% patients had low ALB level in ECOG PS 0, 1–2, and 3–4 groups (p = 0.002). Similarity, in patients with IPI score 0–1, 2–3, and 4–5, a total of 21.75%, 58.5% and 66.7% population, respectively, had low ALB level (p = 0.005). We therefore analyzed the ALB level in each ECOG PS group and IPI score group. The average serum ALB level was 38.47 ± 4.89, 34.98 ± 6.74, and 28.08 ± 9.17 g/L in ECOG PS 0, 1–2 and 3–4 groups respectively (P = 0.002). A similar tendency was observed in terms of IPI score groups with 38.27 ± 7.39, 33.36 ± 5.98, and 31.61 ± 8.67 g/L (p = 0.007), as shown in Fig. 4.

Fig. 4figure 4

Association between serum ALB and ECOG PS (A) as well as IPI score (B). The average ALB level in ECOG PS groups (C) and IPI score groups (D). Abbreviations: ALB, albumin; IPI, International Prognosis Index; ECOG PS, Eastern Cooperative Oncology Group performance status

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