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Prognostic value of C-reactive protein predicting all-cause and cause-specific mortality: a prospective cohort study
Juzhong Ke1, Qingping Liu1, Xiaolin Liu1
1Shanghai Pudong New Area Center for Disease Control and Prevention (Shanghai Pudong New Area Health Supervision Institute), Shanghai, China.
Insights
Elevated C-reactive protein (CRP) levels independently predict higher risks of all-cause, cardiovascular, and cancer mortality in a Chinese population. This inflammation marker improves mortality prediction beyond traditional factors.
Area of Science:
- Epidemiology
- Biomarkers
- Public Health
Background:
- C-reactive protein (CRP) is a marker of inflammation.
- Its role in predicting mortality in diverse populations requires further investigation.
- Community-based studies are crucial for understanding population health trends.
Purpose of the Study:
- To examine the predictive value of CRP for all-cause and cause-specific mortality.
- To assess the association between CRP levels and mortality in a Chinese cohort.
- To determine if CRP improves existing mortality risk prediction models.
Main Methods:
- Prospective community-based cohort study in Shanghai, China.
- 9360 residents followed for a median of 10.52 years.
- Cox proportional hazards models and competing risk analyses were used, adjusting for numerous covariates.
Main Results:
- Higher CRP levels were significantly associated with increased all-cause, cardiovascular, and cancer mortality.
- Non-linear associations were found between CRP and all-cause/cancer mortality.
- CRP addition significantly enhanced the predictive ability of conventional risk models for all-cause and cancer mortality.
Conclusions:
- Elevated CRP levels are an independent predictor of mortality.
- CRP indicates low-grade inflammation, a significant risk factor.
- CRP can improve mortality risk stratification in clinical practice.
Objectives:
To investigate the role of C-reactive protein (CRP) in predicting all-cause and cause-specific mortality in a community-based Chinese cohort.
Design:
A community-based prospective cohort study.
Setting:
34 communities in Pudong New Area, Shanghai, China.
Participants:
A total of 9360 permanent residents from 34 randomly selected communities were enrolled in 2013. Follow-up began at baseline and continued until death or 30 September 2023, whichever occurred first.
Main Outcome Measures:
The primary outcome of this study was death, as recorded in the Vital Registry of Pudong New Area, Shanghai, China. Associations between CRP and risks of all-cause and cause-specific mortality were studied. Cox proportional hazards models were applied to estimate HR and 95% CI. Adjustments were made for age, sex, area, marriage status, education, current smoking, alcohol consumption, physical activity, body mass index, systolic blood pressure, diastolic blood pressure, type 2 diabetes, dyslipidaemia and chronic kidney disease. Competing risk analyses were performed for cause-specific mortality. Restricted cubic splines were used to assess potential non-linear associations. We evaluated improvements in mortality prediction by calculating changes in the C-index, integrated discrimination improvement and net reclassification improvement after adding CRP to conventional risk factor models.
Results:
Over a median follow-up of 10.52 (IQR: 10.43-10.56) years, 920 deaths (9.68 per 1000 person-years) were recorded. After adjusting for traditional risk factors, higher baseline CRP levels were significantly associated with increased risk of all-cause mortality, cardiovascular mortality and cancer mortality. Non-linear associations were observed between CRP levels and all-cause and cancer mortality. The addition of CRP level significantly improved the reclassification and discrimination ability beyond the conventional risk factor models for all-cause mortality and cancer mortality.
Conclusions:
Elevated CRP levels, indicative of low-grade inflammation, are an independent risk factor for all-cause, cardiovascular and cancer mortality.
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