The impact of residual inflammatory risk of albumin combined with C-reactive protein on long-term mortality in cardiovascular disease patients

Abstract

Abstract Purpose The secondary prevention strategy for cardiovascular disease (CVD) does not include anti-inflammatory treatment, which may lead to some patients being in a high inflammatory state for a long time. The aim of this study was to assess the association between the residual inflammatory risk based on Glasgow Outcome Score (GPS) and long-term mortality in patients with CVD. Methods This study included 3833 patients (≥ 20 years old) with CVD in the National Health and Nutrition Survey from 1999 to 2010. The death result is determined by the correlation with the national death index on December 31, 2019. GPS consists of serum C-reactive protein and albumin. The main outcome was all-cause death, including cardiac death and non-cardiac death. The Cox proportional hazards adjusted for demographic factors and traditional cardiovascular risk factors were used to test the impact of GPS level on mortality. The sensitivity analysis included components of CVD, heart failure, coronary heart disease, angina, heart attack, and stroke. Results Among 3833 CVD patients with a median follow-up of 9.6 years, 2431 all-cause deaths, 822 cardiac deaths, and 1609 non-cardiac deaths were recorded. After full model adjustment, compared with the GPS (0) group, the risk ratio (HR) of all-cause death for GPS (1) and GPS (2) were 1.667 (95% confidence interval (CI), 1.490–1.865) and 2.835 (95% CI, 2.077–3.869), respectively (P for trend < 0.001). Compared with the GPS (0) group, the HR of cardiac death for GPS (1) and GPS (2) were 1.693 (95% CI, 1.395–2.053) and 2.268 (95% CI, 1.264–4.070), respectively (P for trend < 0.001). Compared with the GPS (0) group, the HR of non-cardiac death for GPS (1) and GPS (2) were 1.656 (95% CI, 1.443–1.901) and 3.136 (95% CI, 2.171–4.530), respectively (P for trend < 0.001). The results of the sensitivity analysis were almost consistent with the overall cohort. Conclusions Using the US national database, and adjusting for a large number of potential confounders through flexible modeling, we found that residual inflammatory risk based on GPS was strongly associated with a increased risk of death in patients with CVD and that the higher GPS level was associated with an increased risk of death, and this score, which consists of readily available biomarkers, may in the future be used for risk stratification and potentially for improving patient outcomes.