Report on Prognostic Indicators for Myelodysplastic Syndrome and Alignment with Sustainable Development Goals

Introduction: Advancing SDG 3 (Good Health and Well-being)

In alignment with Sustainable Development Goal 3, which aims to ensure healthy lives and promote well-being for all at all ages, a recent study investigates prognostic factors for low-risk myelodysplastic syndrome (MDS). The research, conducted by Tuba Ersal, M.D., and colleagues, contributes to Target 3.4 by seeking to reduce premature mortality from non-communicable diseases through improved prevention and treatment. The retrospective analysis involved 175 patients and examined the impact of inflammation, nutritional status, and oxidative stress on disease prognosis.

Key Findings: The Intersection of Nutrition, Health, and Disease (SDG 2 & SDG 3)

The study’s findings underscore the critical link between nutrition and health outcomes, directly addressing SDG 2 (Zero Hunger), which seeks to end all forms of malnutrition. A low Prognostic Nutritional Index (PNI) was identified as a significant predictor of poor prognosis, highlighting the vulnerability of patients with inadequate nutritional status, a key concern of SDG 2.2.

• Independent Prognostic Factors: A low PNI and a high systemic oxidative stress (SOS) score were independently associated with poorer prognosis, with hazard ratios of 1.598 and 1.003, respectively.
• Mortality Prediction: The optimal PNI cutoff value for predicting mortality was determined to be 47.47.
• Survival Disparity: A significant difference in median overall survival was observed between patient groups based on the PNI cutoff. The low-PNI group (92 patients) had a median survival of 45.5 months, compared to 75.1 months for the high-PNI group (83 patients).
• Disease Progression: The PNI was not found to have a significant association with the progression of MDS to acute myeloid leukemia (AML).

Comprehensive Prognostic Predictors

A multivariate analysis of overall survival identified several independent factors that predict patient outcomes. These markers are crucial for developing targeted health interventions as promoted by SDG 3.

1. High Revised International Prognostic Scoring System (R-IPSS) score
2. Low Prognostic Nutritional Index (PNI)
3. High systemic oxidative stress (SOS) score
4. Advanced age
5. Male gender
6. Transformation to acute myeloid leukemia (AML)

Implications for Global Health Targets and Future Research (SDG 3 & SDG 17)

The authors suggest that these findings open potential therapeutic avenues. The use of anti-inflammatory or antioxidant therapies could play a role in slowing disease progression in MDS, contributing directly to the achievement of SDG 3 health targets. To ensure these findings can be applied globally and integrated into routine clinical practice, the authors call for further research. This recommendation supports SDG 17 (Partnerships for the Goals), emphasizing the need for “prospective, multicenter studies” to validate and generalize the results, fostering collaboration within the global medical community.

SDGs, Targets, and Indicators Analysis

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article directly addresses health issues by focusing on myelodysplastic syndrome (MDS), a non-communicable disease. It investigates factors that predict patient prognosis and mortality, which is central to ensuring healthy lives and promoting well-being. The discussion of potential “anti-inflammatory or antioxidant therapies” also aligns with the goal of improving health outcomes.
2. SDG 2: Zero Hunger
   • The article establishes a clear link between nutritional status and health outcomes through the “Prognostic Nutritional Index (PNI).” A low PNI, indicating poor nutritional status (a form of malnutrition), is associated with a poorer prognosis and lower survival rates. This connects the article to the goal of ending all forms of malnutrition and addressing the nutritional needs of vulnerable populations, such as patients with chronic diseases.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • The research focuses on MDS, a type of cancer, which is a non-communicable disease (NCD). By identifying prognostic factors like PNI and SOS scores, the study aims to improve the management and treatment of MDS, ultimately contributing to the reduction of premature mortality. The article explicitly discusses “predicting mortality” and differences in “median overall survival.”
2. Target 2.2: By 2030, end all forms of malnutrition… and address the nutritional needs of… older persons.
   • The study’s use of the Prognostic Nutritional Index (PNI) directly addresses the issue of malnutrition. It demonstrates that poor nutritional status is a significant predictor of mortality in MDS patients, who are often older persons. This highlights the importance of addressing the nutritional needs of this specific patient group to improve their health outcomes, which is a core component of this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease.
   • The article provides specific data that can be used to measure this indicator. It reports on the “median overall survival” for patients with MDS (a cancer), showing a significant difference between the low-PNI group (45.5 months) and the high-PNI group (75.1 months). This data directly measures mortality rates within a specific cancer patient population.
2. Implied Indicator: Prevalence of malnutrition measured by the Prognostic Nutritional Index (PNI).
   • While not an official UN indicator, the PNI is used in the article as a direct, quantifiable measure of nutritional status, which is central to Target 2.2. The study defines a clear “optimal PNI cutoff value” of 47.47 and categorizes patients into “low” (92 patients) and “high” (83 patients) PNI groups, effectively measuring the prevalence of poor nutritional status within the study cohort.
3. Implied Indicator: Use of risk prediction scores in clinical practice.
   • The article proposes the PNI and SOS scores as tools for predicting prognosis. The authors’ call for further studies to “support their integration into routine clinical practice” implies that the adoption rate of such prognostic tools could serve as an indicator for strengthening the capacity for risk management of NCDs, relevant to Target 3.d (Strengthen the capacity… for early warning, risk reduction and management of… health risks).

4. Table of SDGs, Targets, and Indicators

Source: physiciansweekly.com