Systemic inflammation predicts all-cause mortality: a glasgow inflammation outcome study.
BACKGROUND
Markers of the systemic inflammatory response, including C-reactive protein and albumin (combined to form the modified Glasgow Prognostic Score), as well as neutrophil, lymphocyte and platelet counts have been shown to be prognostic of survival in patients with cancer. The aim of the present study was to examine the prognostic relationship between these markers of the systemic inflammatory response and all-cause, cancer, cardiovascular and cerebrovascular mortality in a large incidentally sampled cohort.


METHODS
Patients (n = 160 481) who had an incidental blood sample taken between 2000 and 2008 were studied for the prognostic value of C-reactive protein (>10mg/l, albumin (>35mg/l), neutrophil (>7.5×109/l) lymphocyte and platelet counts. Also, patients (n = 52 091) sampled following the introduction of high sensitivity C-reactive protein (>3mg/l) measurements were studied. A combination of these markers, to make cumulative inflammation-based scores, were investigated.


RESULTS
In all patients (n = 160 481) C-reactive protein (>10mg/l) (HR 2.71, p<0.001), albumin (>35mg/l) (HR 3.68, p<0.001) and neutrophil counts (HR 2.18, p<0.001) were independently predictive of all-cause mortality. These associations were also observed in cancer, cardiovascular and cerebrovascular mortality before and after the introduction of high sensitivity C-reactive protein measurements (>3mg/l) (n = 52 091). A combination of high sensitivity C-reactive protein (>3mg/l), albumin and neutrophil count predicted all-cause (HR 7.37, p<0.001, AUC 0.723), cancer (HR 9.32, p<0.001, AUC 0.731), cardiovascular (HR 4.03, p<0.001, AUC 0.650) and cerebrovascular (HR 3.10, p<0.001, AUC 0.623) mortality.


CONCLUSIONS
The results of the present study showed that an inflammation-based prognostic score, combining high sensitivity C-reactive protein, albumin and neutrophil count is prognostic of all-cause mortality.
Academic unit of Surgery, School of Medicine-University of Glasgow, Glasgow, United Kingdom.
Michael J
MJ
Proctor
Academic unit of Surgery, School of Medicine-University of Glasgow, Glasgow, United Kingdom.
Donald C
DC
McMillan
Academic unit of Surgery, School of Medicine-University of Glasgow, Glasgow, United Kingdom.
Paul G
PG
Horgan
Department of Clinical Biochemistry, Royal Infirmary, Glasgow, United Kingdom.
Colin D
CD
Fletcher
Department of Clinical Biochemistry, Royal Infirmary, Glasgow, United Kingdom.
Dinesh
D
Talwar
West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow, United Kingdom.
David S
DS
Morrison
D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000166:cytology; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D007958:Leukocyte Count; D008214:Lymphocytes / Q000166:cytology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000473:pathology; D009504:Neutrophils / Q000166:cytology; D010976:Platelet Count; D011379:Prognosis; D012709:Serum Albumin / Q000032:analysis*; D016019:Survival Analysis
D012709:Serum Albumin; D002097:C-Reactive Protein