Amyotrofik Lateral Sklerozda CRP/Albumin Oranının Klinik Parametreler, Prognoz ve Fizyoterapi ile İlişkisinin Araştırılması: Amyotrofik Lateral Sklerozda CRP/Albumin Oranı

Öz

Amaç: Bu çalışmanın amacı, Amyotrofik Lateral Sklerozlu (ALS) hastalarda başlangıç CRP/albümin oranı (CAR) değerinin klinik parametreler, tedavi sonrası fonksiyonel kapasite ve fizyoterapi etkinliği ile ilişkisini araştırmaktır. Yöntem: Bu çalışma için 16 Haziran 2023 tarihinde E. Kurul-2023-21/751 numarasıyla etik onay alındı. Bu retrospektif çalışma Ocak 2021 ile Ocak 2024 tarihleri arasında gerçekleştirildi. ALS tanısı almış 57 hasta arasından kan testi sonuçları, Revize Amyotrofik Lateral Skleroz Fonksiyonel Değerlendirme Ölçeği (ALSFRS-R) skor kayıtları ve hastalıkla ilişkili klinik bulguları elektronik hasta raporu aracılığıyla erişilen 45 hasta çalışmaya dahil edildi. Herhangi bir şikayeti olmadan Check-up polikliniğine başvuran benzer yaş ve cinsiyetteki 45 sağlıklı kişi kontrol grubu olarak çalışmaya dahil edildi. Bulgular: Çalışmaya 45 ALS tanılı hasta ve 45 sağlıklı kişi kontrol grubu olmak üzere toplam 90 kişi dahil edildi. Her iki grubun kadın/erkek oranı ve yaş ortalamaları benzerdi ve istatistiksel olarak fark yoktu. ALS'li hastaların ortalama CAR'ı 1,92±0,14 iken, kontrol grubunun ortalama CAR'ı 0,82±0,15 idi ve ortalama CAR açısından gruplar arasında anlamlı bir fark yoktu (p: 0,2). Beyaz Küre Hücresi (WBC) ve Nötrofil, ALS grubunda kontrol grubuna göre anlamlı olarak daha yüksekti (p:0,017, p:0,038). CAR'ın ALS'nin klinik parametreleri ve alınan fizyoterapi seansı sayısı ile ilişkili olmadığı bulundu. Fonksiyonel ambulasyon Ölçeği puanlarının, fizyoterapi seansı sayısı arttıkça daha yüksek olduğu bulundu. Sonuç: Bu çalışma, ALS’li hastalarda CAR'ı değerlendirmek için ilk çalışmadır. ALS hastalığının tanısı sırasında ölçülen CAR, kontrol grubundan anlamlı olarak daha yüksek değildi ve CAR ile tedavi sonrası fonksiyonel puanlar arasında bir ilişki bulamadık. Ancak, CAR, özellikle hastalık ilerlediğinde ve komplikasyonlar geliştiğinde yetersiz beslenmeyi ve kronik inflamasyonu değerlendirmede önemli bir parametre olabilir.

Anahtar Kelimeler

• Amyotrofik Lateral Skleroz
• CRP/Albümin oranı
• Amyotrofik Lateral Skleroz Fonksiyonel Derecelendirme Ölçeği
• fizyoterapi etkinliği

Investigation of the Relationship of CRP/Albumin Ratio with Clinical Parameters, Prognosis and Physiotherapy in Amyotrophic Lateral Sclerosis CRP/Albumin Ratio in Amyotrophic Lateral Sclerosis

Öz

Aim: The aim of this study was to investigate relationship of onset CAR value with clinical parameters, post treatment functional capacity and physiotherapy effectiveness in patients with Amyotrophic Lateral Sclerosis (ALS). Method: Ethical approval was obtained for this study on June 16, 2023, with number E. Kurul-2023-21/751. This retrospective study was undertaken between January 2021 and January 2024. Forty-five patients whose blood test results, Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score records and disease-related clinical findings were accessed through electronic patient report were included in study among 57 patients diagnosed with ALS. Forty-five healthy people of similar age and gender who attended check-up clinic without any complaints were included in study as a control group. Results: A total of 90 people, 45 patients with ALS and 45 healthy people as control group were included in study. The female/male ratio and mean age of both groups were similar and there was no statistical difference. The mean CAR of patients with ALS was 1.92±0.14, while mean CAR of control group 0.82±0,15 and there was no significant difference between groups in terms of mean CAR (p: 0.2). WBC and Neutrophil were significantly higher in ALS group according to control group (p:0.017, p:0.038). CAR was not found to correlate with clinical parameters of ALS and number of physiotherapy sessions received. Functional ambulation Scale scores were found to be higher as number of physical therapy sessions increased. Conclusion: This study is first to evaluate CAR in ALS patients. CAR measured at time of diagnosis of ALS disease was not significantly higher than control group, and we could not find a relationship between CAR and post treatment functional scores. However, CAR may be an important parameter, especially in evaluating malnutrition and chronic inflammation when disease progresses and complications develop.

Anahtar Kelimeler

• Amyotrophic Lateral Sclerosis
• CRP/Albumin ratio
• Amyotrophic Lateral Sclerosis Functional Rating Scale
• physiotherapy effectiveness

Etik Beyan

Acibadem Mehmet Ali Aydinlar University Medical Research Evaluation Committee approval was obtained before starting the study (E.Kurul- 2023-21/751).

Kaynakça

1. 1. Masrori P, Van Damme P. Amyotrophic lateral sclerosis: A clinical review. European Journal of Neurology. 2020;27(10):1918-29.
2. 2. Xu L, Liu T, Liu L, et al. Global variation in prevalence and incidence of amyotrophic lateral sclerosis: A systematic review and meta-analysis. Journal of Neurology. 2020;267:944-53.
3. 3. Trojsi F, D’Alvano G, Bonavita S, et al. Genetics and sex in the pathogenesis of amyotrophic lateral sclerosis (ALS): Is there a link? International Journal of Molecular Sciences. 2020;21(10):3647.
4. 4. Jankovic M, Novakovic I, Gamil Anwar Dawod P, et al. Current concepts on genetic aspects of mitochondrial dysfunction in amyotrophic lateral sclerosis. International Journal of Molecular Sciences. 2021;22(18):9832.
5. 5. Aktekin M, Uysal H. Epidemiology of amyotrophic lateral sclerosis. Turkish Journal of Neurology. 2020;26(3).
6. 6. Spencer KR, Foster ZW, Rauf NA, et al. Neuropathological profile of long‐duration amyotrophic lateral sclerosis in military veterans. Brain Pathology. 2020;30(6):1028-40.
7. 7. Bashford J, Mills K, Shaw C. The evolving role of surface electromyography in amyotrophic lateral sclerosis: A systematic review. Clinical Neurophysiology. 2020;131(4):942-50.
8. 8. Štětkářová I, Ehler E. Diagnostics of amyotrophic lateral sclerosis: Up to date. Diagnostics. 2021;11(2):231.

9. 9. Silva JPR, Júnior JBS, Dos Santos EL, et al. Quality of life and functional independence in amyotrophic lateral sclerosis: A systematic review. Neuroscience & Biobehavioral Reviews. 2020;111:1-11.
10. 10. Ortega-Hombrados L, Molina-Torres G, Galán-Mercant A, et al. Systematic review of therapeutic physical exercise in patients with amyotrophic lateral sclerosis over time. International Journal of Environmental Research and Public Health. 2021;18(3):1074.
11. 11. Park D, Kwak SG, Choo YJ, et al. Can therapeutic exercise slow down progressive functional decline in patients with amyotrophic lateral sclerosis? A Meta-Analysis. Frontiers in Neurology. 2020;11:532679.
12. 12. Chapin JL, Gray LT, Vasilopoulos T, et al. Diagnostic utility of the amyotrophic lateral sclerosis Functional Rating Scale—Revised to detect pharyngeal dysphagia in individuals with amyotrophic lateral sclerosis. PloS One. 2020;15(8):e0236804.
13. 13. Belinskaia DA, Voronina PA, Shmurak VI, et al. Serum albumin in health and disease: Esterase, antioxidant, transporting and signaling properties. International Journal of Molecular Sciences. 2021;22(19):10318.
14. 14. Kushner I, Mackiewicz A. The acute phase response: An overview. Acute Phase Proteins Molecular Biology, Biochemistry, and Clinical Applications. 2020;3-19.
15. 15. Ranzani OT, Zampieri FG, Forte DN, et al. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PloS One. 2013;8(3):e59321.
16. 16. Sheinenzon A, Shehadeh M, Michelis R, et al. Serum albumin levels and inflammation. International Journal of Biological Macromolecules. 2021;184:857-62.
17. 17. Fettah E, Demir A. C-reactive protein/albumin ratio in patients with multiple sclerosis and its relationship with disease subtype and disability. Journal of Surgery and Medicine. 2020;4(11):974-7.
18. 18. Jang JH, Hong S, Ryu J-A. Prognostic value of C-reactive protein and albumin in Neurocritically ill patients with acute stroke. Journal of Clinical Medicine. 2022;11(17):5067.
19. 19. Shen J, Amari N, Zack R, et al. Plasma MIA, CRP, and albumin predict cognitive decline in Parkinson's disease. Annals of Neurology. 2022;92(2):255-69.
20. 20. Xie L, Jiang J, Fu H, et al. Malnutrition in relation to muscle mass, muscle quality, and muscle strength in hospitalized older adults. Journal of the American Medical Directors Association. 2022;23(5):722-8.
21. 21. Chełstowska B, Kuźma-Kozakiewicz M. Biochemical parameters in determination of nutritional status in amyotrophic lateral sclerosis. Neurological Sciences. 2020;41:1115-24.
22. 22. Cheng Y, Chen Y, Shang H. Aberrations of biochemical indicators in amyotrophic lateral sclerosis: A systematic review and meta-analysis. Translational Neurodegeneration. 2021;10:1-12.
23. 23. Monov D, Molodozhnikova N. Biochemical parameters as a tool to assess the nutritional status of patients with amyotrophic lateral sclerosis. Frontiers in Neurology. 2024;14:1258224.
24. 24. Sun J, Carrero J, Zagai U, et al. Blood biomarkers and prognosis of amyotrophic lateral sclerosis. European Journal of Neurology. 2020;27(11):2125-33.
25. 25. Cui C, Sun J, Pawitan Y, et al. Creatinine and C-reactive protein in amyotrophic lateral sclerosis, multiple sclerosis and Parkinson’s disease. Brain Communications. 2020;2(2):fcaa152.
26. 26. Kharel S, Ojha R, Preethish‐Kumar V, et al. C‐reactive protein levels in patients with amyotrophic lateral sclerosis: A systematic review. Brain and Behavior. 2022;12(3):e2532.
27. 27. Ferri A, Lanfranconi F, Corna G, et al. Tailored exercise training counteracts muscle disuse and attenuates reductions in physical function in individuals with amyotrophic lateral sclerosis. Frontiers in Physiology. 2019;10:500721.
28. 28. Alencar MA, Guedes MCB, Pereira TAL, et al. Functional ambulation decline and factors associated in amyotrophic lateral sclerosis. Fisioterapia em Movimento. 2022;35:e35127.
29. 29. Filiz K, Balal M, Demir T, et al. Adaptation to Turkish and reliability study of the revised amyotrophic lateral sclerosis functional rating scale (ALSFRS-R). Archives of Neuropsychiatry. 2016;53(3):229.
30. 30. George D, Maller P. SPSS for windows step by step: A simple study guide and reference, 17.0 update. 10th ed. Boston: Allyn & Bacon; 2011.
31. 31. Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics. Pearson Boston: MA; 2013.
32. 32. Mehta P, Raymond J, Punjani R, et al. Prevalence of amyotrophic lateral sclerosis (ALS), United States, 2016. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration. 2022;23(3-4):220-5.
33. 33. Chen L, Xu L, Tang L, et al. Trends in the clinical features of amyotrophic lateral sclerosis: A 14‐year Chinese cohort study. European Journal of Neurology. 2021;28(9):2893-900.
34. 34. Feldman EL, Goutman SA, Petri S, et al. Amyotrophic lateral sclerosis. The Lancet. 2022;400(10360):1363-80.
35. 35. Goutman SA, Hardiman O, Al-Chalabi A, et al. Recent advances in the diagnosis and prognosis of amyotrophic lateral sclerosis. The Lancet Neurology. 2022;21(5):480-93.
36. 36. Richards D, Morren JA, Pioro EP. Time to diagnosis and factors affecting diagnostic delay in amyotrophic lateral sclerosis. Journal of the Neurological Sciences. 2020;417:117054.
37. 37. Gregory JM, Fagegaltier D, Phatnani H, et al. Genetics of amyotrophic lateral sclerosis. Current Genetic Medicine Reports. 2020;8:121-31.
38. 38. Yazar T, Yazar HO. Evaluation of C-reactive protein/albumin ratio according to stage in patients with idiopathic parkinson disease. Turkish Journal of Neurology. 2019;25(3):123-8.
39. 39. Braga ACM, Pinto A, Pinto S, et al. The role of moderate aerobic exercise as determined by cardiopulmonary exercise testing in ALS. Neurology Research International. 2018;2018.
40. 40. Sivaramakrishnan A, Madhavan S. Recumbent stepping aerobic exercise in amyotrophic lateral sclerosis: A pilot study. Neurological Sciences. 2019;40:971-8.