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Published on: January 28, 2020
Association of inflammatory risk based on the Glasgow Prognostic Score with long-term mortality in patients with
Houyong Zhu1, Chao Yang2, Xiao Liu2
1Department of Cardiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, No. 453 Stadium Road, Hangzhou, 310007, Zhejiang, China. houyongzhu@foxmail.com.
Insights
The Glasgow Prognostic Score (GPS), a measure of inflammation, is linked to higher long-term mortality in cardiovascular disease (CVD) patients. Higher GPS scores indicate increased risks for all-cause, cardiac, and non-cardiac death, suggesting its use in risk stratification.
Area of Science:
- Cardiovascular Medicine
- Inflammation Research
- Public Health
Background:
- Current cardiovascular disease (CVD) secondary prevention strategies often overlook anti-inflammatory treatments, potentially leaving some patients with persistent long-term inflammation.
- Inflammation is increasingly recognized as a significant factor in the prognosis of cardiovascular diseases.
- The Glasgow Prognostic Score (GPS), utilizing serum C-reactive protein and albumin levels, serves as a readily available marker for systemic inflammation.
Purpose of the Study:
- To investigate the association between inflammatory risk, as indicated by the Glasgow Prognostic Score (GPS), and long-term mortality in patients diagnosed with cardiovascular disease (CVD).
- To evaluate the predictive value of GPS for all-cause, cardiac, and non-cardiac mortality in a large CVD cohort.
- To explore the utility of GPS as a tool for risk stratification in cardiovascular disease management.
Main Methods:
- Analysis of 3833 adult patients with CVD from the US National Health and Nutrition Examination Survey (1999-2010), with mortality data linked to the National Death Index through December 31, 2019.
- The Glasgow Prognostic Score (GPS) was calculated based on serum C-reactive protein and serum albumin levels.
- Cox proportional hazards models, adjusted for demographic and traditional cardiovascular risk factors, were employed to assess the impact of GPS on mortality outcomes. Sensitivity analyses were performed on specific CVD subgroups.
Main Results:
- Over a median follow-up of 9.6 years, 2431 (63.4%) all-cause deaths occurred.
- Compared to patients with GPS 0, those with GPS 1 and GPS 2 exhibited significantly increased hazard ratios for all-cause mortality (HR 1.66 and 2.75, respectively; P for trend < 0.001).
- Elevated GPS scores were also significantly associated with increased risks of cardiac death (HRs 1.69 and 2.18 for GPS 1 and 2) and non-cardiac death (HRs 1.65 and 3.05 for GPS 1 and 2), with similar trends observed in sensitivity analyses.
Conclusions:
- The Glasgow Prognostic Score (GPS) is a significant independent predictor of long-term all-cause, cardiac, and non-cardiac mortality in patients with cardiovascular disease (CVD).
- Higher GPS scores, reflecting greater systemic inflammation, are associated with substantially increased mortality risks.
- The GPS, using easily accessible biomarkers, represents a valuable tool for enhancing risk stratification and potentially improving outcomes for patients with CVD.
Abstract:
The secondary prevention strategy for cardiovascular disease (CVD) does not include anti-inflammatory treatment, which may lead to long-term inflammation in some patients. The aim of this study was to assess the association between inflammatory risk based on the Glasgow Prognostic Score (GPS) and long-term mortality risk in patients with CVD. This study included 3833 patients (≥ 20 years old) with CVD in the National Health and Nutrition Survey from 1999 to 2010 in the United States. The mortality rate was determined by correlation with the National Death Index on December 31, 2019. The GPS consists of the serum C-reactive protein and the serum albumin. The primary outcome was all-cause death, which included cardiac death and non-cardiac death. Cox proportional hazards adjusted for demographic factors and traditional cardiovascular risk factors were used to test the impact of the GPS on mortality. The sensitivity analysis was conducted on subsets within the cohort of patients with CVD, including congestive heart failure, coronary artery disease, angina, heart attack, and stroke. Among 3833 CVD patients with a median follow-up of 9.6 years, 2431 (63.4%) all-cause deaths, 822 (21.4%) cardiac deaths, and 1609 (41.9%) non-cardiac deaths were recorded. After full model adjustment, compared with those of the GPS (0) group, the hazard ratios (HRs) of all-cause death for GPS (1) and GPS (2) were 1.66 (95% confidence interval (CI), 1.48-1.86) and 2.75 (95% CI 2.01-3.75), respectively (P for trend < 0.001). Compared with those of the GPS (0) group, the HRs of cardiac death for the GPS (1) and GPS (2) groups were 1.69 (95% CI 1.39-2.05) and 2.18 (95% CI 1.22-3.91), respectively (P for trend < 0.001). Compared with those of the GPS (0) group, the HRs of non-cardiac death for the GPS (1) and GPS (2) groups were 1.65 (95% CI 1.44-1.89) and 3.05 (95% CI 2.11-4.40), respectively (P for trend < 0.001). The results of the sensitivity analysis were similar to those of the overall cohort. In our analysis of the United States National Database, we discovered that the GPS, a measure of inflammatory risk, was significantly associated with an increased risk of mortality among patients with CVD. Specifically, we observed that patients with a higher GPS had significantly higher risks of all-cause, cardiac, and non-cardiac mortality compared to those with a lower score. These findings suggest that the GPS, comprising easily obtainable biomarkers, could serve as a valuable tool for risk stratification in CVD patients and may contribute to the improvement of patient outcomes.
