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

By Michael J. Proctor, Donald C. McMillan, Paul G. Horgan, Colin D. Fletcher, Dinesh Talwar, David S. Morrison

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There is now good evidence that markers of the systemic inflammatory response, namely C-reactive protein and albumin using standard thresholds (termed the Glasgow Prognostic Score, GPS) have independent prognostic value in patients with a variety of cancers [1]. Similarly, neutrophils and lymphocytes using standard thresholds (termed the neutrophil lymphocyte ratio, NLR) have also been shown to have independent prognostic value [2]. Recently, in an effort to rationalise and consolidate the literature we have examined the relationship between these markers of the systemic inflammatory response, together with high sensitivity C-reactive protein measurements and platelet counts, and survival in more than 12,000 cancer patients. This resulted in an optimised score (termed the optimised Glasgow Prognostic Score, oGPS) composed of high sensitivity C-reactive protein (>3mg/l), albumin (<35g/l), neutrophil (>7.5 x 109) and platelet (>400 x 109) counts that had a superior predictive value when compared with the established GPS [3]. It remains to be determined whether such markers and scores also are associated with survival in other disease states.
It is therefore of interest that there have been numerous reports investigating the relationship between an elevated C-reactive protein concentration and increased risk of cardiovascular [4–6], cerebrovascular [5,7] and all-cause mortality [8,9]. There have also been occasional reports of other markers of the systemic inflammatory response, including albumin [10,11], neutrophil count [12], lymphocyte count [13,14] and platelet count [15] being associated with all cause mortality.
Therefore, the aim of the present study was to examine the relationship between markers of the systemic inflammatory response and all-cause, cancer, cardiovascular and cerebrovascular mortality, in a large incidental cohort.