Pretreatment hyperuricemia and hypoalbuminemia as predictors for one-year mortality in diffuse large B-cell lymphoma beyond the international prognostic index

Abstract

Background: Diffuse large B-cell lymphoma (DLBCL) is prevalent in Thailand; however, real-world data identifying risk factors for mortality in local practice remain limited.

Objective: This study aimed to evaluate the one-year mortality rate and identify risk factors for early death among patients with DLBCL treated with chemotherapy.

Methods: This single-center retrospective study analyzed data from medical records of patients newly diagnosed with DLBCL between 2019 and 2025 at a provincial hospital in Thailand. Patients who received palliative or end-of-life care shortly after diagnosis were excluded. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of mortality within the first year of treatment. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported.

Results: Of 97 eligible patients (54% male; mean age ± standard deviation, 63.1 ± 12.2 years), the one-year mortality rate was 24%. Univariate analysis demonstrated significant associations between one-year mortality and age ≥60 years, poor performance status, Ann Arbor stage III-IV, anemia, chronic kidney disease stages 3-5, a low prognostic nutritional index, B-symptoms, serum albumin <3.0 g/dL, serum uric acid ≥6.8 mg/dL and an international prognostic index (IPI) ≥3. Multivariate analysis identified three independent predictors of mortality: high IPI (aOR, 11.80; 95% CI, 1.36-91.88; P=0.03), hypoalbuminemia (aOR, 5.92; 95% CI, 1.59-22.06; P=0.008) and hyperuricemia (aOR, 3.74; 95% CI 1.19-11.78; P=0.02).

Conclusions: The one-year mortality rate among patients with DLBCL in rural Thailand was 24%. In addition to the standard IPI, pretreatment hypoalbuminemia and hyperuricemia were identified as independent predictors of early mortality in DLBCL.