{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:10:32Z","timestamp":1788952232958,"version":"build-2803163510"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Routine blood tests are often combined into composite indices meant to summarize nutritional, inflammatory, or metabolic status in a single value. Whether these indices reflect the broad syndrome burden seen in geriatric outpatients is unclear, since most of the supporting evidence comes from oncological or surgical cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We reviewed the records of 289 patients seen consecutively at a geriatric outpatient clinic over an approximately one-year period and calculated thirteen indices from the first available laboratory panel. The outcome was multisyndrome burden, scored across ten geriatric syndromes, with a burden of four or more defined as high. Each index was entered into a separate logistic regression adjusted for age, sex, comorbidity, and polypharmacy, and the thirteen\n                      <jats:italic>p<\/jats:italic>\n                      -values were corrected for multiple testing with the Benjamini\u2013Hochberg procedure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Only the Prognostic Nutritional Index (PNI) and the HALP score remained associated with high burden after correction (adjusted odds ratio per standard deviation 0.55 and 0.64, respectively); none of the inflammatory or metabolic indices reached significance in the full cohort, although the neutrophil-to-lymphocyte ratio and the systemic immune-inflammation index did so in the subgroup in whom all ten components were assessed. Removing the two activity-of-daily-living measures from the outcome left neither association significant, which places the relationship mainly on functional status rather than on an independent inflammatory pathway. Neither index discriminated better than serum albumin measured alone (PNI, area under the curve 0.679 vs. 0.677, DeLong\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.90; HALP, 0.654 vs. 0.677,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.52).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Taken together, the results argue against treating composite laboratory indices as independent markers of geriatric vulnerability: their apparent value largely reflects the albumin and functional components already captured in routine assessment. A low PNI or HALP may still draw attention to a patient who warrants closer functional evaluation, but should not replace direct geriatric assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1931199","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:17:31Z","timestamp":1788949051000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Routine laboratory composite indices and geriatric multisyndrome burden: a head to head evaluation against serum albumin"],"prefix":"10.3389","volume":"13","author":[{"given":"K\u00fcbra","family":"Erdo\u011fan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Geriatrics, Ankara Bilkent City Hospital","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u0131dvan","family":"Erten","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Geriatrics, Faculty of Medicine, Kocaeli University","place":["Kocaeli, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1196","DOI":"10.1016\/S0140-6736(09)61460-4","article-title":"Ageing populations: the challenges ahead","volume":"374","author":"Christensen","year":"2009","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1111\/j.1532-5415.2007.01156.x","article-title":"Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept","volume":"55","author":"Inouye","year":"2007","journal-title":"J Am Geriatr Soc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"156","DOI":"10.7326\/0003-4819-147-3-200708070-00004","article-title":"Geriatric conditions and disability: the health and retirement study","volume":"147","author":"Cigolle","year":"2007","journal-title":"Ann Intern Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1111\/j.1532-5415.2008.02150.x","article-title":"The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study","volume":"57","author":"Lee","year":"2009","journal-title":"J Am Geriatr Soc"},{"key":"B5","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1186\/s12916-014-0171-9","article-title":"Standard laboratory tests to identify older adults at increased risk of death","volume":"12","author":"Howlett","year":"2014","journal-title":"BMC Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/0002-9610(80)90246-9","article-title":"Prognostic nutritional index in gastrointestinal surgery","volume":"139","author":"Buzby","year":"1980","journal-title":"Am J Surg"},{"key":"B7","first-page":"1001","article-title":"Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients","volume":"85","author":"Onodera","year":"1984","journal-title":"Nihon Geka Gakkai Zasshi"},{"key":"B8","doi-asserted-by":"publisher","first-page":"41370","DOI":"10.18632\/oncotarget.5629","article-title":"Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study","volume":"6","author":"Chen","year":"2015","journal-title":"Oncotarget"},{"key":"B9","doi-asserted-by":"publisher","first-page":"109496","DOI":"10.1016\/j.intimp.2022.109496","article-title":"Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: a systematic review and meta-analysis of 13,110 patients","volume":"114","author":"Xu","year":"2023","journal-title":"Int Immunopharmacol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"147","author":"Von Elm","year":"2007","journal-title":"Ann Intern Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1001\/jama.1963.03060120024016","article-title":"Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function","volume":"185","author":"Katz","year":"1963","journal-title":"JAMA"},{"key":"B13","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of older people: self-maintaining and instrumental activities of daily living","volume":"9","author":"Lawton","year":"1969","journal-title":"Gerontologist"},{"key":"B14","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d: a practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J Psychiatr Res"},{"key":"B15","first-page":"273","article-title":"Reliability and validity of the standardized Mini mental state examination in the diagnosis of mild dementia in the turkish population","volume":"13","author":"G\u00fcngen","year":"2002","journal-title":"Turk Psikiyatri Derg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"M366","DOI":"10.1093\/gerona\/56.6.M366","article-title":"Screening for undernutrition in geriatric practice: developing the short-form Mini-nutritional assessment (MNA-SF)","volume":"56","author":"Rubenstein","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/0022-3956(82)90033-4","article-title":"Development and validation of a geriatric depression screening scale: a preliminary report","volume":"17","author":"Yesavage","year":"1982","journal-title":"J Psychiatr Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1300\/J018v05n01_09","article-title":"Geriatric depression scale (GDS): recent evidence and development of a shorter version","volume":"5","author":"Sheikh","year":"1986","journal-title":"Clin Gerontol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1017\/S1041610200006293","article-title":"Reliability, validity, and factor structure of the geriatric depression scale in turkish elderly: are there different factor structures for different cultures?","volume":"12","author":"Ertan","year":"2000","journal-title":"Int Psychogeriatr"},{"key":"B20","doi-asserted-by":"publisher","first-page":"216","DOI":"10.14744\/nci.2017.85047","article-title":"Validity and reliability of geriatric depression scale-15 (short form) in turkish older adults","volume":"5","author":"Durmaz","year":"2018","journal-title":"North Clin Istanb"},{"key":"B21","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1093\/biomet\/52.3-4.591","article-title":"An analysis of variance test for normality (complete samples)","volume":"52","author":"Shapiro","year":"1965","journal-title":"Biometrika"},{"key":"B22","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s10654-019-00494-6","article-title":"Principles of confounder selection","volume":"34","author":"VanderWeele","year":"2019","journal-title":"Eur J Epidemiol"},{"key":"B23","doi-asserted-by":"crossref","DOI":"10.1002\/9781118548387","volume-title":"Applied Logistic Regression","author":"Hosmer","year":"2013"},{"key":"B24","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1093\/aje\/kwk052","article-title":"Relaxing the rule of ten events per variable in logistic and cox regression","volume":"165","author":"Vittinghoff","year":"2007","journal-title":"Am J Epidemiol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J R Stat Soc Series B"},{"key":"B26","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"B27","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1007\/BF03324614","article-title":"Change in serum albumin and subsequent decline in functional status in older persons","volume":"17","author":"Schalk","year":"2005","journal-title":"Aging Clin Exp Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1016\/j.jgo.2020.03.013","article-title":"Prognostic nutritional index (PNI), independent of frailty, is associated with six-month postoperative mortality","volume":"11","author":"Cadwell","year":"2020","journal-title":"J Geriatr Oncol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1038\/s41569-018-0064-2","article-title":"Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty","volume":"15","author":"Ferrucci","year":"2018","journal-title":"Nat Rev Cardiol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1016\/S0140-6736(97)04430-9","article-title":"Total cholesterol and risk of mortality in the oldest old","volume":"350","author":"Weverling-Rijnsburger","year":"1997","journal-title":"Lancet"},{"key":"B31","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1186\/s12933-023-02002-3","article-title":"Association of triglyceride-glucose index trajectory and frailty in urban older residents: evidence from the 10-year follow-up in a cohort study","volume":"22","author":"Yuan","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1111\/jgs.12147","article-title":"Geriatric syndromes and incident disability in older women: results from the women\u2019s health initiative observational study","volume":"61","author":"Rosso","year":"2013","journal-title":"J Am Geriatr Soc"},{"key":"B33","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1093\/gerona\/59.3.M255","article-title":"Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care","volume":"59","author":"Fried","year":"2004","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1842125","DOI":"10.3389\/fpubh.2026.1842125","article-title":"Association of the HALP score with baseline and incident physical-cognitive comorbidity and mortality: evidence from the WCHAT and UK biobank cohorts","volume":"14","author":"Gao","year":"2026","journal-title":"Front Public Health"},{"key":"B35","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.maturitas.2015.02.009","article-title":"Serum albumin and health in older people: review and meta analysis","volume":"81","author":"Cabrerizo","year":"2015","journal-title":"Maturitas"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1931199\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:17:32Z","timestamp":1788949052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1931199\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":35,"alternative-id":["10.3389\/fmed.2026.1931199"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1931199","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"1931199"}}