title: Biomarker-based score to predict mortality in persons aged 50 years and older: a new approach in the Swedish AMORIS study.
abstract: BACKGROUND
  Management of frailty is the cornerstone of geriatric medicine, but there remains a need to identify biomarkers that can predict early death, and thereby lead to effective clinical interventions. We aimed to study the combination of C-reactive protein (CRP), albumin, gamma-glutamyl transferase (GGT), and HDL to predict mortality.
  
  
  METHODS
  A total of 44,457 persons aged 50+ whose levels of CRP, albumin, GGT, and HDL were measured at baseline were selected from the Swedish Apolipoprotein MOrtality RISk (AMORIS) study. A mortality score, ranging from 0 to 4, was created by adding the number of markers with abnormal values according to the clinical cut-off (CRP > 10 mg/L, albumin < 35 mg/L, GGT > 36 kU/L, HDL < 1.04 mmol/L). Mortality was studied with multivariate Cox proportional hazards models.
  
  
  RESULTS
  2,245 persons died from cancer, 3,276 from circulatory disease, and 1,860 from other causes. There was a positive trend between mortality score and all-cause mortality as well as cancer and circulatory disease-specific death (e.g. HR for all-cause mortality: 1.39 (95%CI: 1.32-1.46), 2.04 (1.89-2.21), and 3.36 (2.87-3.93), for score=1, 2, and 3+, compared to score=0). Among cancer patients with no other co-morbidities (n=1,955), there was a positive trend between the score and mortality (HR: 1.24 (95%CI: 1.0.-1.49), 2.38 (95%CI: 1.76-3.22), and 5.47 (95%CI: 2.98-10.03) for score=1, 2, and 3+ compared to score=0).
  
  
  CONCLUSIONS
  By combining biomarkers of different mechanisms contributing to patient frailty, we found a strong marker for mortality in persons aged 50+. Elevated risks among cancer patients with no other co-morbidities prior to biomarker assessment call for validation in other cohorts and testing of different combinations and cut-offs than those used here, in order to aid decision-making in treatment of older cancer patients.
authors.affiliation: King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.
authors.forename: Mieke
authors.initials: M
authors.lastname: Van Hemelrijck
authors.forename: Danielle
authors.initials: D
authors.lastname: Harari
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
authors.forename: Goran
authors.initials: G
authors.lastname: Walldius
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
authors.forename: Ingmar
authors.initials: I
authors.lastname: Jungner
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg