title: Inflammation biomarkers and risk of all-cause mortality in the Reasons for Geographic And Racial Differences in Stroke cohort.
abstract: Inflammation biomarkers, including higher high-sensitivity C-reactive protein (hsCRP) levels, higher white blood cell (WBC) counts, and lower serum albumin levels, are associated with an increased risk of all-cause mortality. Many studies have examined these biomarkers individually, but less is known about their joint association with mortality. hsCRP, WBC count, and serum albumin were measured at baseline in the Reasons for Geographic and Racial Differences in Stroke Study cohort members, who were enrolled in 2003-2007. Over 4.5 years, there were 1,062 deaths in 17,845 participants. High-risk categories were defined as hsCRP or WBC levels above the 75th percentile (5.1 mg/L and 6.9 × 10(9) cells/L, respectively) and albumin levels below the 25th percentile (4.00 g/dL). The authors derived 4 groups that corresponded to 0 (n = 8,341), 1 (n = 6,277), 2 (n = 2,635), or 3 (n = 592) biomarkers in the high-risk category. After adjustment for age, sex, waist circumference, race, region, smoking, alcohol use, income, educational level, physical activity frequency, and medical history and compared with those with no biomarkers in the high-risk category, the hazard ratios for all-cause mortality for 1, 2, and 3 biomarkers in the high-risk category were 1.56 (95% confidence interval: 1.33, 1.82), 2.19 (95% confidence interval: 1.84, 2.62), and 2.96 (95% confidence interval: 2.30, 3.80), respectively (P(trend) < 0.0001). Adding the 3 inflammation biomarkers to a fully adjusted model improved risk discrimination by 23.7% (95% confidence interval: 9.3, 39.9). Measurement of more than 1 biomarker is more useful in risk prediction than single biomarkers.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 35294, USA. edmondk@uab.edu
authors.forename: Edmond K
authors.initials: EK
authors.lastname: Kabagambe
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: Neil A
authors.initials: NA
authors.lastname: Zakai
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Jenny
authors.forename: Matthew
authors.initials: M
authors.lastname: Hsieh
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D012737:Sex Factors; D012959:Socioeconomic Factors; D015144:Southeastern United States / Q000453:epidemiology; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D002097:C-Reactive Protein