Systemic Inflammation Predicts All-Cause Mortality: A Glasgow Inflammation Outcome Study

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 (> 7.5x10(9)/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.