title: Ability of a biomarker-based score to predict death from circulatory disease and cancer in NHANES III.
abstract: BACKGROUND
  A score based on serum concentrations of C-reactive protein (CRP), albumin, gamma-glutamyl transferase (GGT), and HDL cholesterol was positively associated with death from cancer, circulatory disease, and all-cause mortality. We replicated this in the third National Health and Nutrition Examination Survey (NHANES III), a US nationally representative survey conducted between 1988-1994.
  
  
  METHODS
  Baseline measurements of CRP, albumin, GGT, and HDL were available for participants with mortality follow-up (n=13,056). A biomarker score, ranging 0-4, was created by adding number of markers with abnormal values (cut-off: CRP>10mg/L, albumin<35mg/L, GGT>36U/L, HDL<1.04mmol/L). Its association with mortality was analyzed with multivariate Cox proportional hazards models.
  
  
  RESULTS
  The score was positively associated with death from all causes, cancer and circulatory disease [e.g. HR all-cause mortality: 1.21 (95% CI: 1.09, 1.35), 1.92 (1.67, 2.20), 3.38 (2.62, 4.36), and 7.93 (5.77, 10.89), for score 1, 2, 3, 4 vs.0]. These patterns were found across the Charlson Comorbidity Index (CCI). Where CCI =3, risk of cancer death was 1.09 (0.93, 1.28), 1.81 (1.43, 2.29), 4.67 (3.05, 7.14), and 6.97 (5.32, 9.14) for score 1, 2, 3, 4 vs. 0. No effect-modification by sex or race/ethnicity was observed.
  
  
  CONCLUSIONS
  These findings correlate with results from a Swedish study. This biomarker-based score could help clinicians make decisions in prevention and disease management.
authors.affiliation: King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, Guy's Hospital, London, SE1 9RT, UK. mieke.vanhemelrijck@kcl.ac.uk
authors.forename: Mieke
authors.initials: M
authors.lastname: Van Hemelrijck
authors.forename: Monika
authors.initials: M
authors.lastname: Eichholzer
authors.forename: David
authors.initials: D
authors.lastname: Faeh
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
mesh_terms: D000328:Adult; D000418:Albumins / Q000032:analysis*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D002423:Cause of Death; D008076:Cholesterol, HDL / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000401:mortality*; D009749:Nutrition Surveys; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D000418:Albumins; D015415:Biomarkers; D008076:Cholesterol, HDL; D002097:C-Reactive Protein; D005723:gamma-Glutamyltransferase