Association between baseline inflammation and the effectiveness of nutritional support among terminally ill patients with cancer: A secondary analysis of a multicenter prospective cohort study.

OBJECTIVES

Inflammatory status may influence the response to nutritional support. We aimed to determine associations between calorie intake and survival considering serum C-reactive protein (CRP) levels among advanced cancer patients.

METHODS

Data on characteristics and CRP levels were obtained at baseline. The nutritional administration method and calorie intake during the first week were recorded. Patients were divided into three CRP groups: Low (<1 mg/dL), moderate (1-10 mg/dL), or high (≥10 mg/dL). Patients in each group were divided into two categories: low-calorie (<250 kcal/d) or high-calorie (≥250 kcal/d). We assessed survival using the Kaplan-Meier method and calculated multivariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) using Cox proportional hazard models.

RESULTS

A total of 1233 patients were divided into three CRP groups: Low (n = 223), moderate (n = 718), and high (n = 292). Significant differences were observed in survival rates between the high- and low-calorie categories in all groups (all log-rank P < 0.001). Significantly lower risks of mortality were observed in the Cox proportional hazard model for the high-calorie category than for the low-calorie category in all CRP groups (adjusted HR 0.37, 95% CI 0.26-0.52 in the low group; adjusted HR 0.38, 95% CI 0.32-0.45 in the moderate group; adjusted HR 0.44, 95% CI 0.34-0.56 in the high group). The lower the CRP level, the lower the risk of death in the high-calorie category.

CONCLUSIONS

Nutritional support had beneficial effects on patient outcomes regardless of CRP levels.