title: Additive value of interleukin-6 and C-reactive protein in risk prediction for all-cause and cardiovascular mortality among a representative adult cohort in Taiwan.
abstract: OBJECTIVE
  Interleukin-6 (IL-6) and C-reactive protein (CRP) are inflammatory makers of potential interest in all-cause and cardiovascular death risk prediction, but their additive explanatory value to established risk factors is not well documented among nonwestern populations.
  
  
  METHODS
  We investigated the additive value of IL-6 and CRP to the Framingham risk score and lifestyle factors in predicting all-cause and cardiovascular mortality among a population-representative sample of 1023 adults aged 54 years and above in Taiwan.
  
  
  RESULTS
  A total of 351 deaths and 82 cardiovascular deaths were identified (median follow-up = 11.2 years). After adjustment for established risk factors, elevated IL-6 and CRP levels were associated with a higher risk of all-cause death: the hazard ratios for the highest risk quartile compared with the lowest quartile were 3.64 (95% confidence interval, 2.44-5.44) for IL-6 and 2.31 (95% confidence interval, 1.62-3.29) for CRP. IL-6 was also significantly associated with cardiovascular mortality. For both all-cause and cardiovascular mortality, IL-6 yielded a substantial and significant increase in the area under the receiver operator characteristic curve (change in the area under the receiver operator characteristic curve = 0.036 and 0.024, respectively), but CRP did not (change in the area under the receiver operator characteristic curve = 0.004 and 0.009, respectively).
  
  
  CONCLUSIONS
  Although both IL-6 and CRP were significantly associated with all-cause mortality, only IL-6 provided a substantial improvement in discrimination. Similarly, IL-6 demonstrated a notable prognostic value for predicting cardiovascular mortality, but not CRP. These findings provide further support for the role of inflammation in the deterioration of health at older ages among a nonwestern population.
authors.affiliation: Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Hsuan
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Center for Population and Health, Georgetown University, Washington, DC, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Glei
authors.affiliation: Center for Population and Health, Georgetown University, Washington, DC, USA.
authors.forename: Maxine
authors.initials: M
authors.lastname: Weinstein
authors.affiliation: Food and Drug Administration, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Shiow-Ing
authors.initials: SI
authors.lastname: Wu
authors.affiliation: Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: klchien@ntu.edu.tw.
authors.forename: Kuo-Liong
authors.initials: KL
authors.lastname: Chien
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein
keywords: C-reactive protein; cardiovascular disease; inflammation; interleukin-6; mortality