Pretreatment hyperuricemia and hypoalbuminemia as predictors for one-year mortality in diffuse large B-cell lymphoma beyond the international prognostic index
DOI:
https://doi.org/10.69898/jhtm.36.2026.286242Keywords:
Albumin, Diffuse large B-cell lymphoma, Mortality, Uric acid, ThailandAbstract
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.
Downloads
References
Intragumtornchai T, Bunworasate U, Wudhikarn K, Lekhakula A, Julamanee J, Chansung K, et al. Non‐Hodgkin lymphoma in Southeast Asia: an analysis of the histopathology, clinical features, and survival from Thailand. Hematol Oncol. 2018;36:28-36.
Sukpanichnant S, Sonakul D, Piankijagum A, Wanachiwanawin W, Veerakul G, Mahasandana C, et al. Malignant lymphoma in Thailand: changes in the frequency of malignant lymphoma determined from a histopathologic and immunophenotypic analysis of 425 cases at Siriraj Hospital. Cancer. 1998;83:1197-204.
Kunlayawutipong T, Rattanathammethee T, Punnachet T, Hantrakun N, Piriyakhuntorn P, Hantrakool S, et al. Prevalence and risk factors for hyperuricemia and hyperuricosuria in patients with hematologic malignancies. Front Med (Lausanne). 2024;11:1343000.
Przekop Z, Milewska M, Szostak-Wegierek D, Panczyk M, Sobocki J. GLIM-defined malnutrition in patients with head and neck cancer during the qualification visit for home enteral nutrition. Nutrients. 2022;14:502.
Luan C, Wang F, Wei N, Chen B. Prognostic nutritional index and the prognosis of diffuse large B-cell lymphoma: a meta-analysis. Cancer Cell Int. 2020;20:455.
Wieringa A, Boslooper K, Hoogendoorn M, Joosten P, Beerden T, Storm H, et al. Comorbidity is an independent prognostic factor in patients with advanced-stage diffuse large B-cell lymphoma treated with R-CHOP: a population-based cohort study. Br J Haematol. 2014;165:489-96.
Suttantapidok S, Owattanapanich W. Survival outcomes among Thai, elderly, non-Hodgkin lymphoma patients: a 5-year cohort study. J Hematol Transfus Med. 2019;29:301-10.
Hedström G, Hagberg O, Jerkeman M, Enblad G. The impact of age on survival of diffuse large B-cell lymphoma – a population-based study. Acta Oncol. 2015;54:916-23.
Xu H, Yan R, Ye C, Li J, Ji G. Specific mortality in patients with diffuse large B-cell lymphoma: a retrospective analysis based on the surveillance, epidemiology, and end results database. Eur J Med Res. 2024;29:241.
Kim K, Jorge VM, Tiu A, Mousaa P, Gupta S, Djibo D, et al. Early mortality after diagnosis of diffuse large B-cell lymphoma: a retrospective, single urban-community hospital study. Blood. 2019;134:5335.
Zhao J, Su L, Zhong J. Risk factors for cancer-specific mortality and cardiovascular mortality in patients with diffuse large B-cell lymphoma. Clin Lymphoma Myeloma Leuk. 2020;20:e858-e863.
Chen L, Pan L, Liu T. Prognostic value of serum albumin level in patients with diffuse large B-cell lymphoma. Acta Biochim Pol. 2023;70:767-76.
Bairey O, Shacham A, Shpilberg O, Gurion R. Serum albumin level at diagnosis of diffuse large B-cell lymphoma: an important simple prognostic factor. Hematol Oncol. 2016;34:184-92.
Wei X, Zheng J, Zhang Z, Liu Q, Zhan M, Huang W, et al. Consecutive hypoalbuminemia predicts inferior outcome in patients with diffuse large B-cell lymphoma. Front Oncol. 2021;10:610681.
Hohloch K, Ziepert M, Truemper L, Buske C, Held G, Poeschel V, et al. Low serum albumin is an independent risk factor in elderly patients with aggressive B-cell lymphoma: results from prospective trials of the German High-Grade Non-Hodgkin's Lymphoma Study Group. EJHaem. 2020;1:181-7.
Wei Y, Wei X, Huang W, Song J, Zeng H, Zheng J, et al. Albumin improves stratification in the low IPI risk patients with diffuse large B-cell lymphoma. Int J Hematol. 2020;111:681-5.
He J, Yin H, Xia Y, Wu JZ, Liang JH, Zhu HY, et al. Prognostic nutritional index, a novel biomarker which predicts worse prognosis in diffuse large B-cell lymphoma. Leuk Res. 2021;110:106664.
Liu X, Duan Y, Wang Y, Zhang X, Lv H, Li Q, et al. Predictive value of prognostic nutritional index as prognostic biomarkers in patients with lymphoma: a systematic review and meta-analysis. Clin Transl Oncol. 2025;27:1274-87.
Go SI, Park S, Kang MH, Kim HG, Kim HR, Lee GW. Clinical impact of prognostic nutritional index in diffuse large B-cell lymphoma. Ann Hematol. 2019;98:401-11.
Dendle C, Gilbertson M, Spelman T, Stuart RL, Korman TM, Thursky K, et al. Infection is an independent predictor of death in diffuse large B-cell lymphoma. Sci Rep. 2017;7:4395.
Cho SF, Liu YC, Hsiao HH, Huang CT, Tsai YF, Wang HC, et al. Investigation on treatment strategy, prognostic factors, and risk factors for early death in elderly Taiwanese patients with diffuse large B-cell lymphoma. Sci Rep. 2017;7:44282.
Qian S, Yiwei L. Prognostic value of pre-therapy serum uric acid in diffuse large B-cell lymphoma. Blood. 2018;132(Suppl 1):5418.
Talaulikar D, Choudhury A, Shadbolt B, Brown M. Lymphocytopenia as a prognostic marker for diffuse large B-cell lymphomas. Leuk Lymphoma. 2008;49:959-64.
Cox MC, Nofroni I, Ruco L, Amodeo R, Ferrari A, La Verde G, et al. Low absolute lymphocyte count is a poor prognostic factor in diffuse large B-cell lymphoma. Leuk Lymphoma. 2008;49:1745-51.
Porrata LF, Ristow K, Habermann T, Inwards DJ, Micallef IN, Markovic SN. Predicting survival for diffuse large B-cell lymphoma patients using baseline neutrophil/lymphocyte ratio. Am J Hematol. 2010;85:896-9.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Journal of Hematology and Transfusion Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
