title: Optimization of the systemic inflammation-based Glasgow prognostic score: a Glasgow Inflammation Outcome Study.
abstract: BACKGROUND
  The modified Glasgow Prognostic Score (mGPS), an inflammation-based prognostic score that uses thresholds of C-reactive protein (> 10 mg/L) and albumin (< 35 g/L), has been found to be independently prognostic of survival in patients with cancer. The objective of the current study was to establish whether the addition of a differential leukocyte count and a high-sensitivity C-reactive protein measurement enhanced the prognostic value of the mGPS.
  
  
  METHODS
  A total of 12,119 patients who had an incidental blood sample taken between 2000 and 2007 for C-reactive protein, albumin, and a differential leukocyte count as well as a diagnosis of cancer made within 2 years were identified. This group was studied for the prognostic value of neutrophil, lymphocyte, and platelet counts. In addition 2742 patients whose blood was sampled after the introduction of high-sensitivity C-reactive protein measurements were studied for the prognostic value of different thresholds.
  
  
  RESULTS
  Using cancer-specific survival as an endpoint, the prognostic value of the mGPS (hazard ratio [HR], 2.61; P < .001 [area under the receiver operating characteristic curve (AUC), 0.695]) was found to be improved by the addition of neutrophil and platelet counts (HR, 4.86; P < .001 [AUC, 0.734]) and a high-sensitivity C-reactive protein measurement (> 3 mg/L) (HR, 5.77; P < .001 [AUC, 0.734]).
  
  
  CONCLUSIONS
  The results of the current study demonstrate that the addition of neutrophil and platelet counts, as well as a high-sensitivity C-reactive protein measurement, enhanced the prognostic value of the mGPS.
authors.affiliation: Academic Unit of Surgery, University of Glasgow School of Medicine, Royal Infirmary, Glasgow, UK. michael.j.proctor@gmail.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Proctor
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.forename: Dinesh
authors.initials: D
authors.lastname: Talwar
authors.forename: Colin D
authors.initials: CD
authors.lastname: Fletcher
authors.forename: David S
authors.initials: DS
authors.lastname: Morrison
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000401:mortality* / Q000503:physiopathology*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D009504:Neutrophils; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D012606:Scotland; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein