Journal article
Predictive Value of Glycated Hemoglobin and Body Mass Index for Pretreatment Neuropathy in Patients With Multiple Myeloma
Clinical lymphoma, myeloma and leukemia, Vol.16(2), pp.89-95
01 Feb 2016
PMID: 26689624
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
We assessed 29 patients with newly diagnosed multiple myeloma (MM) for peripheral neuropathy using the Total Neuropathy Score, reduced (TNSr) and Total Neuropathy Score, clinical (TNSc). Neuropathy was found in 51.7% and 17.2% of patients by TNSr and TNSc, respectively. Glycated hemoglobin (HbA1c) ≥ 5.6% and body mass index (BMI) ≥ 23.7 kg/m2 predicted baseline neuropathy. This may indicate the contribution of abnormal glucose metabolism and metabolic syndrome to pretreatment neuropathy in patients with MM.
Peripheral neuropathy (PN) is detected in up to 62% patients with multiple myeloma (MM) at diagnosis. No specific risk factor for pretreatment neuropathy has been identified.
We evaluated 29 sequential patients with MM attending our tertiary care center for peripheral neuropathy at diagnosis using symptoms, clinical examination, and nerve conduction studies (NCSs). Total Neuropathy Score, reduced (TNSr) and Total Neuropathy Score, clinical (TNSc) were calculated, and a score of ≥ 2 in each scale was considered diagnostic of PN. The study was approved by our institutional review board.
We found that 51.7% (n = 15) and 17.2% (n = 5) of patients had pretreatment neuropathy by TNSr and TNSc scales, respectively. Higher glycated hemoglobin (HbA1C) (P = .022), higher body mass index (BMI) (P = .008), higher serum creatinine levels (P = .023), and higher blood urea levels (P = .006) were associated with neuropathy by TNSr in univariate analysis. Higher blood urea levels (P = .023), higher serum creatinine levels (P = .003), and higher serum β2-microglobulin levels (P = .013) were associated with neuropathy by TNSc in univariate analysis. Higher HbA1c levels (P = .036; odds ratio [OR], 9.46) and BMI (P = .028; OR, 1.78) were associated with neuropathy by TNSr on binomial logistic regression analysis. Cutoffs of 5.6% (sensitivity, 60%; specificity, 71.4%) and 23.7 kg/m2 (sensitivity, 80%; specificity, 71.4%) were obtained for HbA1c (area under the curve [AUC], 0.75) and BMI (AUC, 0.79), respectively, on receiver operating characteristic (ROC) curve analysis to predict neuropathy. The combination of HbA1c ≥ 5.6% and BMI ≥ 23.7 kg/m2 had higher odds of neuropathy by TNSr (OR, 27.0; 95% confidence interval [CI], 2.0-368.4) when compared with either factor alone.
Use of TNSr, which incorporates electrophysiological abnormalities in addition to clinical manifestations, improves the detection rate of neuropathy. We found that high HbA1c and high BMI together are risk factors for neuropathy at diagnosis in patients with MM.
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Details
- Title
- Predictive Value of Glycated Hemoglobin and Body Mass Index for Pretreatment Neuropathy in Patients With Multiple Myeloma
- Creators
- Arjun Lakshman - Post Graduate Institute of Medical Education and ResearchManish Modi - Post Graduate Institute of Medical Education and ResearchGaurav Prakash - Post Graduate Institute of Medical Education and ResearchPankaj Malhotra - Post Graduate Institute of Medical Education and ResearchAlka Khadwal - Post Graduate Institute of Medical Education and ResearchVikas Suri - Post Graduate Institute of Medical Education and ResearchPinaki Dutta - Post Graduate Institute of Medical Education and ResearchSanjay Jain - Post Graduate Institute of Medical Education and ResearchSavita Kumari - Post Graduate Institute of Medical Education and ResearchNeelam Varma - Post Graduate Institute of Medical Education and ResearchSubhash Varma - Post Graduate Institute of Medical Education and Research
- Publication Details
- Clinical lymphoma, myeloma and leukemia, Vol.16(2), pp.89-95
- Publisher
- Elsevier Inc
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000370903400006
- Scopus ID
- 2-s2.0-84949663560
- Other Identifier
- 991022059809604721
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- Hematology
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