Nutritional-inflammatory and laboratory-derived fibrosis indices in FMF-related AA amyloidosis: associations with advanced kidney disease and mortality

Ertuğrul Çağrı Bölek; Burak Karakaya; Rıza Can Kardaş; Abdulsamet Erden; Hamit Küçük

Nutritional-inflammatory and laboratory-derived fibrosis indices in FMF-related AA amyloidosis: associations with advanced kidney disease and mortality

Abstract

Aims: Amyloid A (AA) amyloidosis is among the most serious systemic consequences of familial Mediterranean fever (FMF), particularly because of its renal burden. We investigated whether the fibrosis-4 index (FIB-4), the Aspartate Aminotransferase to-Platelet Ratio Index (APRI), HALP, and Prognostic Nutritional Index (PNI), calculated from routinely obtained laboratory data, were related to advanced kidney disease and all-cause mortality in this population. Methods: We retrospectively analyzed adults with FMF and AA amyloidosis at a single center. FIB-4 APRI, HALP, and PNI were derived from each patient’s most recent eligible laboratory assessment. Their relationships with all-cause mortality were examined with Cox regression, while chronic kidney disease (CKD) G5 was analyzed as a cross-sectional binary outcome using logistic regression. PNI and FIB-4 were entered simultaneously in two-variable models; no additional clinical covariates were included. Because the indices were derived from last-available measurements, the analyses were intended to assess association rather than prospective prediction. Results: Fifteen of 97 patients died over a median observation period of 89.8 months, while CKD G5 was present in 28 of the 95 patients with available renal classification. Lower PNI values were observed both among patients who died and among those with CKD G5, whereas higher FIB-4 values characterized the latter group. With both indices included in the models, each 1-point increase in PNI corresponded to a lower mortality hazard (HR, 0.90; 95% CI, 0.84–0.96; p=0.001) and lower odds of CKD G5 (OR, 0.92; 95% CI, 0.86–0.98; p=0.009). FIB-4 showed associations in univariable models, but these became weaker after mutual adjustment. Conclusion: PNI showed the more consistent relationship with mortality and advanced kidney disease, while the findings for FIB-4 were less robust after mutual adjustment. Because both indices are readily obtainable from routine laboratory data, they may offer complementary information on systemic disease burden; prospective studies using predefined baseline measurements are needed before prognostic application.

Keywords

Supporting Institution

N/A

Project Number

Research Code: 2026-1353

Ethical Statement

The study was approved by the Gazi University Ethics Commission on July 21, 2026 (Reference No: E-77082166-604.01-1591000; Research Code: 2026-1353) and was conducted in accordance with the ethical principles of the World Medical Association Declaration of Helsinki, including its 2024 revision. Because the study retrospectively analyzed anonymized routinely collected clinical data without direct patient contact or study-related intervention, the requirement for informed consent was waived.

Thanks

N/A

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Details

Primary Language

English

Subjects

Internal Diseases, Rheumatology and Arthritis

Journal Section

Research Article

Authors

Ertuğrul Çağrı Bölek ^*
0000-0003-3886-2813
Türkiye

Burak Karakaya
0000-0002-6184-7876
Türkiye

Rıza Can Kardaş
0000-0003-0730-8959
Türkiye

Abdulsamet Erden
0000-0002-8084-2018
Türkiye

Hamit Küçük
0000-0003-1206-4725
Türkiye

Publication Date

October 25, 2026

Submission Date

August 9, 2026

Acceptance Date

September 19, 2026

Published in Issue

Year 2026 Volume: 7 Number: 5

IZ

https://izlik.org/JA52LP95UX

Cite

RIS / Bibtex

APA

Bölek, E. Ç., Karakaya, B., Kardaş, R. C., Erden, A., & Küçük, H. (2026). Nutritional-inflammatory and laboratory-derived fibrosis indices in FMF-related AA amyloidosis: associations with advanced kidney disease and mortality. Journal of Medicine and Palliative Care, 7(5), 1066-1074. https://izlik.org/JA52LP95UX

AMA

1.Bölek EÇ, Karakaya B, Kardaş RC, Erden A, Küçük H. Nutritional-inflammatory and laboratory-derived fibrosis indices in FMF-related AA amyloidosis: associations with advanced kidney disease and mortality. J Med Palliat Care / JOMPAC / jompac. 2026;7(5):1066-1074. https://izlik.org/JA52LP95UX

Chicago

Bölek, Ertuğrul Çağrı, Burak Karakaya, Rıza Can Kardaş, Abdulsamet Erden, and Hamit Küçük. 2026. “Nutritional-Inflammatory and Laboratory-Derived Fibrosis Indices in FMF-Related AA Amyloidosis: Associations With Advanced Kidney Disease and Mortality”. Journal of Medicine and Palliative Care 7 (5): 1066-74. https://izlik.org/JA52LP95UX.

EndNote

Bölek EÇ, Karakaya B, Kardaş RC, Erden A, Küçük H (October 1, 2026) Nutritional-inflammatory and laboratory-derived fibrosis indices in FMF-related AA amyloidosis: associations with advanced kidney disease and mortality. Journal of Medicine and Palliative Care 7 5 1066–1074.

IEEE

[1]E. Ç. Bölek, B. Karakaya, R. C. Kardaş, A. Erden, and H. Küçük, “Nutritional-inflammatory and laboratory-derived fibrosis indices in FMF-related AA amyloidosis: associations with advanced kidney disease and mortality”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 5, pp. 1066–1074, Oct. 2026, [Online]. Available: https://izlik.org/JA52LP95UX

ISNAD

Bölek, Ertuğrul Çağrı - Karakaya, Burak - Kardaş, Rıza Can - Erden, Abdulsamet - Küçük, Hamit. “Nutritional-Inflammatory and Laboratory-Derived Fibrosis Indices in FMF-Related AA Amyloidosis: Associations With Advanced Kidney Disease and Mortality”. Journal of Medicine and Palliative Care 7/5 (October 1, 2026): 1066-1074. https://izlik.org/JA52LP95UX.

JAMA

1.Bölek EÇ, Karakaya B, Kardaş RC, Erden A, Küçük H. Nutritional-inflammatory and laboratory-derived fibrosis indices in FMF-related AA amyloidosis: associations with advanced kidney disease and mortality. J Med Palliat Care / JOMPAC / jompac. 2026;7:1066–1074.

MLA

Bölek, Ertuğrul Çağrı, et al. “Nutritional-Inflammatory and Laboratory-Derived Fibrosis Indices in FMF-Related AA Amyloidosis: Associations With Advanced Kidney Disease and Mortality”. Journal of Medicine and Palliative Care, vol. 7, no. 5, Oct. 2026, pp. 1066-74, https://izlik.org/JA52LP95UX.

Vancouver

1.Ertuğrul Çağrı Bölek, Burak Karakaya, Rıza Can Kardaş, Abdulsamet Erden, Hamit Küçük. Nutritional-inflammatory and laboratory-derived fibrosis indices in FMF-related AA amyloidosis: associations with advanced kidney disease and mortality. J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Oct. 1;7(5):1066-74. Available from: https://izlik.org/JA52LP95UX