Systemic inflammation predicts all-cause mortality: a glasgow inflammation outcome study

PLoS One. 2015 Mar 2;10(3):e0116206. doi: 10.1371/journal.pone.0116206. eCollection 2015.

Abstract

Introduction: 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.

Conclusion: 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.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Platelets / cytology
  • C-Reactive Protein / analysis*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / mortality
  • Cerebrovascular Disorders / diagnosis
  • Cerebrovascular Disorders / mortality
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Inflammation / pathology*
  • Leukocyte Count
  • Lymphocytes / cytology
  • Male
  • Middle Aged
  • Neoplasms / mortality
  • Neoplasms / pathology
  • Neutrophils / cytology
  • Platelet Count
  • Prognosis
  • Serum Albumin / analysis*
  • Survival Analysis

Substances

  • Serum Albumin
  • C-Reactive Protein

Grant support

The authors have no support or funding to report.