Evaluation of Serum Albumin and Globulin in Combination With C-Reactive Protein Improves Serum Diagnostic Accuracy for Low-Grade Periprosthetic Joint Infection.

BACKGROUND: Serum immune markers can be useful in the diagnosis of periprosthetic joint infection (PJI) by detecting long-lasting abnormal immunological conditions. The purpose of this study was to examine whether serum immune markers can improve the diagnostic accuracy of PJI. METHODS: We enrolled 51 PJI, 45 aseptic loosening, and 334 osteoarthritis patients for assessment of the discriminatory accuracy of serum markers including white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer, total protein, albumin (Alb), globulin (Glb), neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, albumin-globulin ratio (AGR), CRP-albumin ratio (CAR), and CRP-AGR ratio (CAGR). These diagnostic accuracies for low-grade PJI were also calculated in patients who had serum CRP levels < 10 mg/L. RESULTS: Among serum markers, Alb, Glb, AGR, CRP, ESR, CAR, and CAGR had highly accurate diagnostic accuracy for PJI, with area under the curve of 0.92, 0.90, 0.96, 0.97, 0.92, 0.97, and 0.98, respectively. In low-grade PJI patients, area under the curve of CRP, ESR, CAR, and CAGR (0.69, 0.80, 0.65, and 0.82, respectively) was decreased but that of Alb, Glb, and AGR (0.90, 0.88, and 0.95, respectively) remained high, indicating the diagnostic utility of these immune markers. The sensitivity and specificity of AGR with cutoff value of 1.1 were demonstrated as 0.92 and 0.89, respectively, and with cutoff value of 1.2, 1.00, and 0.79, respectively, in the diagnosis of low-grade infection. CONCLUSION: Our results demonstrate the potential value of Alb, Glb, AGR, and combination indices of these immune makers with CRP in improving preoperative serum diagnosis for PJI, especially in low-grade PJI. LEVEL OF EVIDENCE: Diagnostic- Level II.

Serum albumin levels and serum albumin-globulin ratio are associated with poor prognosis in glioblastoma.

BACKGROUND: Serum albumin levels (ALB) and albumin-globulin ratio (AGR) are reliable and convenient markers of the nutritional status and inflammation of human body, and ALB has been identified as a prognostic factor in the patients of glioblastoma (GBM). However, no literature has reported the prediction value of AGR for GBM. METHODS: In this study we evaluate the serum ALB and AGR levels for GBM. A total of 126 patients with GBM who underwent surgical resection in our institution between 2013 and 2017 were analyzed retrospectively. Clinical information was obtained from electronic medical records. Multiple logistic regression and Cox proportional hazards models were used to assess the prediction value of preoperative ALB and AGR for GBM. RESULTS: Preoperative ALB (HR 0.342, 95% CI, 0.123-0.954, P=0.040) and postoperative adjuvant therapy (HR 0.042, 95% CI, 0.005-0.330, P=0.003) were significantly related to progression-free survival (PFS). Cox regression analysis showed the significance of adjuvant therapy (HR 3.579, 95% CI, 2.236-5.729, P<0.001). Preoperative AGR (HR 0.280, 95% CI, 0.103-0.763, P=0.013) and adjuvant therapy (HR 0.156, 95% CI, 0.047-0.513, P=0.002) were showed significance, and Cox regression analysis showed preoperative AGR (HR 1.810, 95% CI, 1.095-2.992, P=0.021) and adjuvant therapy (HR 4.702, 95% CI, 2.841-7.782, P<0.001) were independent predictors of overall survival (OS). CONCLUSIONS: The ALB and AGR had significant predictive values for the prognosis of GBM; postoperative adjuvant treatment is also an independent predictor for the prognosis of GBM patients.

Prognostic Value of Clinical Biochemistry-Based Indexes in Nasopharyngeal Carcinoma.

Inflammation and nutritional status have significant effects on the prognosis of cancer patients. This study investigated the predictive value of clinical biochemistry-based indexes in nasopharyngeal carcinoma (NPC). This retrospective study included 559 NPC patients and 500 patients with chronic rhinitis. Continuous variables were measured by t-test. The area under curves (AUC) was used to determine the diagnostic and prognostic value for NPC. Kaplan-Meier methods and the log-rank test were used to analyze overall survival (OS) and disease-free survival (DFS) of the patients. Cox and logistic regression analysis were used to analyze the independent prognostic risk factors for survival and influencing factors of side effects after treatment, respectively. The study results revealed that most indexes of NPC and rhinitis were significantly different between the two groups. In the survival analysis, the systemic inflammation score (SIS), prognostic nutritional index (PNI), albumin/globulin ratio (AGR), albumin (ALB), urea nitrogen (BUN) and creatinine (CREA) had significant influence on the OS and DFS. AGR was the optimal prognostic indicator for NPC. Among these indexes, SIS, AGR, BUN and CERA were independent prognostic factors of OS, AGR and PNI were independent prognostic factors of DFS. Most indexes were risk factors of side effects occurred in radiotherapy. In conclusion, the clinical biochemistry-based indexes, are reliable and of low-cost, therefore, they can be used in predicting diagnosis, prognosis and treatment plans of NPC.

Albumin-globulin ratio: a novel predictor of sepsis after flexible ureteroscopy in patients with solitary proximal ureteral stones.

BACKGROUND: To identify predictors of sepsis after flexible ureteroscopy (fURS) in patients with unilateral, solitary, proximal ureteral stones and evaluate the association between albumin-globulin ratio (AGR) and sepsis. METHODS: Overall, 759 patients who underwent fURS were retrospectively enrolled. Univariate and multivariate logistic regression analyses were performed to identify predictors of sepsis after fURS in patients with solitary proximal ureteral stones. Then A nomogram was generated using the predictors. RESULTS: Sepsis occurred in 43 patients (5.7%), and 6 (0.8%) of them developed septic shock. Univariate analysis showed that age, female sex, albumin concentration, globulin concentration, AGR, pre-operative fever, white blood cell (WBC) count, urine culture (UC) result, urine WBC count, and urine nitrite result were predictors of sepsis. Multivariate analysis identified AGR <1.2 [odds ratio (OR) =2.810, 95% confidence interval (CI): 1.245-6.342, P=0.013] and positive UC (OR =10.520, 95% CI: 4.489-24.653, P<0.001) as independent predictors. When AGR <1.2 and positive UC were combined, area under the receiver operator characteristic curve was 0.825. Then patients were categorized by different AGR level ("≥1.4", "1.2-1.4", "1.0-1.2", "<1.0"), and corresponding sepsis rates were 27.7%, 9.8%, 4.5% and 2.5%. CONCLUSIONS: Positive UC and low AGR were independent predictors of post-fURS sepsis. Cautious pre-operative evaluation and optimized treatment strategy should be considered to minimize infectious complications.

Application of albumin/globulin ratio in elderly patients with acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has become an important disease of hospitalized elderly patients, which lack simple and inexpensive indicators for evaluating the condition and prognosis. This study was performed to investigate the clinical significance of the serum albumin/globulin ratio (AGR) in elderly patients with AECOPD. METHODS: The data of 252 hospitalized elderly patients with AECOPD, 89 stable COPD patients and 115 elderly healthy individuals were analyzed and compared. The differences in the AGR, logarithm of the serum C-reactive protein (LogCRP) level, prealbumin (PA) level, and immunoglobulin G (IgG) level were compared. AECOPD patients were grouped using the optimal cutoff values of each index to compare the difference in the combined infection rate. The correlation between hospital stays and AGR was analyzed. RESULTS: The AGR, LogCRP, PA level, and IgG level were different among the AECOPD group, stable COPD group and healthy control groups (P<0.05). The AGR, LogCRP, and PA level were different (P<0.05) among the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I, II, II, and IV groups. Age, AGR, LogCRP, and PA level were different (P<0.05) between the infection and non-infection groups. After grouping according to the optimal cutoff values, the combined infection rate was different (P<0.05). The AGR was negatively correlated with the hospital stay (r=-0.583, P<0.001). The hospital stay was longer in patients with an AGR of <1.37 than ≥1.37 (P<0.001). CONCLUSIONS: The AGR can be regarded as a reference index for evaluating the condition of elderly patients with AECOPD, determining the presence of combined infection, and predicting the prognosis.