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Open Access Research article

Ability of a biomarker-based score to predict death from circulatory disease and cancer in NHANES III

Mieke Van Hemelrijck1*, Monika Eichholzer2, David Faeh2 and Sabine Rohrmann2

Author affiliations

1 King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, 3rd Floor, Bermondsey Wing, Guy’s Hospital, London, SE1 9RT, UK

2 Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

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Citation and License

BMC Public Health 2012, 12:895  doi:10.1186/1471-2458-12-895

Published: 23 October 2012

Abstract

Background

A score based on serum concentrations of C-reactive protein (CRP), albumin, gamma-glutamyl transferase (GGT), and HDL cholesterol was positively associated with death from cancer, circulatory disease, and all-cause mortality. We replicated this in the third National Health and Nutrition Examination Survey (NHANES III), a US nationally representative survey conducted between 1988–1994.

Methods

Baseline measurements of CRP, albumin, GGT, and HDL were available for participants with mortality follow-up (n=13,056). A biomarker score, ranging 0–4, was created by adding number of markers with abnormal values (cut-off: CRP>10mg/L, albumin<35mg/L, GGT>36U/L, HDL<1.04mmol/L). Its association with mortality was analyzed with multivariate Cox proportional hazards models.

Results

The score was positively associated with death from all causes, cancer and circulatory disease [e.g. HR all-cause mortality: 1.21 (95% CI: 1.09, 1.35), 1.92 (1.67, 2.20), 3.38 (2.62, 4.36), and 7.93 (5.77, 10.89), for score 1, 2, 3, 4 vs.0]. These patterns were found across the Charlson Comorbidity Index (CCI). Where CCI =3, risk of cancer death was 1.09 (0.93, 1.28), 1.81 (1.43, 2.29), 4.67 (3.05, 7.14), and 6.97 (5.32, 9.14) for score 1, 2, 3, 4 vs. 0. No effect-modification by sex or race/ethnicity was observed.

Conclusions

These findings correlate with results from a Swedish study. This biomarker-based score could help clinicians make decisions in prevention and disease management.

Keywords:
Mortality; Albumin; HDL-cholesterol; C-reactive protein; Gamma-glutamyltransferase