Gender aspects of comorbid pathology in patients with chronic lymphocytic leukemia

Summary

Aim

The aim of the study was to study the gender characteristics of comorbid pathology in patients with chronic lymphocytic leukemia (CLL).

Materials and methods

We examined 70 patients (35 men and 35 women) aged from 42 to 80 years. At the time of diagnosis of CLL patients were calculated Charlson comorbidity index (Charlson CI) and glomerular filtration rate (GFR) by the MDRD formula. Charlson CI is a point system for assessing the age and presence of certain comorbidities and is used to assess the prognosis of patients with long-term follow-up. Decline in GFR also serves as a marker for the prognosis of many diseases. It is established that this is one of the risk factors for cardiovascular complications, which lead to an increase in mortality. For statistical evaluation of the obtained data, the average value of the indicator and its standard deviation were calculated. Student t-test was used to compare groups. Correlation analysis was carried out on Pearson. The significance level at p < 0.05 was considered reliable.

Results

The mean age of men and women at diagnosis of CLL was comparable and was 66.4±7.9 years and 67.7±9.6 years, respectively (p ≥ 0.05). Similarly, there were no significant differences in the level of Charlson CI in the groups: 6.5±1.5 in men and 6.8±1.6 in women (p ≥ 0.05). The structure of comorbid pathology included the presence of chronic heart failure (87% – men, 82% – women), chronic non-specific lung diseases (43% – men, 37% – women), violation of cerebral circulation in the history (23% – men, 26% – women), diabetes (14% – men, 17% – women ), kidney and urinary tract diseases (11% – men, 43% – women ), postinfarction cardiosclerosis (11% – men, 8% – women ), connective tissue diseases (0% – men, 3% – women). The calculation of GFR by MDRD showed significant differences in the studing groups. This parameter was significantly lower in the women – 58.7±12.4 ml/min/1,73 m2 compared to the group of the men – 68.8±9.1 ml/min/1,73m2 (p<0.05). At the same time, in the group of women, the inverse correlation between the mean degree of the Charlson CI and GFR was obtained (r=0.58, p=0.02).

Conclusion

The results indicate to different comorbidities in the CLL patients at the time of diagnosis. According to Charlson CI, both groups of the study were diagnosed with low overall 10- year survival (15%). However, there are gender differences in the structure of comorbidities. Thus, among women, kidney and urinary tract pathology is significantly more common, which is reflected by a decrease in GFR in this group compared to men. This fact is not considered by us as a specific feature of CLL patients. It was previously established that the pathology of kidneys and urinary tract occurs in the female population more often than in the male, due to the anatomical features of this part of the body. Taking this fact into account, in the appointment of chemotherapy in women with CLL and Charlson CI more than 6 the rate of GFR should be carefully examined.

Keywords

Chronic lymphocytic leukemia, Charlson comorbidity index, glomerular filtration rate, gender difference.