Low Albumin, High CRP, and Glasgow Prognostic Score as Predictors of Mortality and Malnutrition in Patients with Cancer: Results from nutritionDay 2021-2024 in Iran

Abstract

Background: Malnutrition and systemic inflammation are key determinants of cancer outcomes. Hypoalbuminemia, elevated C-reactive protein (CRP), and the Glasgow Prognostic Score (GPS) are well-established prognostic indicators. However, their predictive value for mortality and malnutrition among hospitalized cancer patients remains unclear. This study investigated their prevalence and clinical associations using data from the Iran oncology nutritionDay survey (2021–2024).

Methods: A cross-sectional study with a 30-day follow-up was performed on 167 cancer patients admitted to the teaching hospitals of Mashhad University of Medical Sciences. Data were collected using standardized nutritionDay questionnaires. Serum albumin, CRP, and GPS were assessed in 124, 123, and 80 patients, respectively. Associations with 30-day mortality and malnutrition were analyzed.

Results: Hypoalbuminemia (<3.5 g/dL) was observed in 61.3% of patients, elevated CRP (≥10 mg/L) in 79.7%, and GPS score of 2 in 61.3%. Malnutrition prevalence was 63.4% to 66.1% in albumin-tested, CRP-tested, and both-tested patients. Hypoalbuminemia increased 30-day mortality (adjusted OR = 5.067, P = 0.015) and malnutrition (OR = 3.452, P = 0.004). High CRP increased mortality (OR = 8.158, P = 0.047) but not malnutrition (P = 0.082). A high GPS result (scores 2) increased mortality (OR = 4.332, P = 0.035) and malnutrition (OR = 3.834, P = 0.011).

Conclusion: Hypoalbuminemia, high CRP levels, and high GPS values were frequent among hospitalized cancer patients and were predictors of poor outcomes. GPS could potentially act as a combined prognostic and nutrition-related biomarker and needs further validation.

Keywords: Glasgow Prognostic Score, cancer, malnutrition, mortality.