Volume 90, June 2024, 102569Author links open overlay panel, , , , Highlights•

The role of C-reactive protein (CRP) in predicting mortality among cancer patients is not well explored.

•

Cancer or elevated CRP alone increase the risk of mortality by at least 20%.

•

Mortality risk more than doubled in individuals with both cancer and elevated CRP.

•

Elevated CRP is a potential predictor of mortality among cancer patients and its role should be explored further.

Abstract

The role of C Reactive Protein (CRP) in predicting long-term outcomes among people living with cancer has not been well explored. We aimed to assess the role of elevated CRP in predicting all-cause mortality among a community-based sample of adult Americans living with cancer. The National Health and Nutrition Examination Survey, 1999–2010 was linked with mortality files up to December 2019 from the National Death Index. Sociodemographic and health-related variables of 30,711 participants (mean age=46.5 years) were analyzed to compute adjusted hazard ratios (HR) for all-cause mortality. The risk of mortality, in unadjusted analysis, was significantly higher among those with cancer compared to those without cancer 3.53 (95% CI= 3.13–3.98, p < 0.001). In adjusted analysis, when stratified by CRP levels (elevated=cutoff point at ≥2 mg/dL), among individuals with elevated CRP but no cancer history, the risk of mortality was significantly higher (HR=1.67, 95% CI=1.24–2.25) compared to those without cancer or elevated CRP. Among individuals with cancer but without elevated CRP as well, the risk of mortality was 20% higher compared to their counterparts. The highest risk of mortality was observed among those with both cancer and elevated CRP (HR=2.10, 95% CI=1.11–4.33). Age and income were significant predictors of these relationships. Among people living with cancer, CRP may serve as a marker for mortality and future studies should explore the pathways by which the risk of mortality may increase due to variation of CRP in cancer patients.

Section snippetsBackground

Cancers are among the leading causes of death worldwide [1]. Within the past few decades, several immune, inflammatory, genetic, and other biomarkers have been assessed for cancer risk, progression, and prognosis [2], [3], [4]. These markers are either specific to a type of cancer or can be non-specific (i.e., present across a wide variety of malignancies). Despite these advances, the search for more reliable markers continues and the known biomarkers are also being explored for their role in

Participants & measures

The National Health and Nutrition Examination Survey (NHANES) 1999–2010 is a nationally representative, multistage, probabilistic sample of Americans. For this study, we included adults 20 years and older and linked NHANES data with Public-Use Mortality Files up to December 31, 2019 [17], [18], [19]. Cancer survivors were those respondents who said yes to the question “Ever told you have a cancer or malignancy”. Detection of CRP was done by latex-enhanced nephelometry using a Siemens/Behring

Results

Table 1 provides data on the health and sociodemographic characteristics of the study participants (N=30,711) based on whether or not they had cancer (Cancer positive = 6910, 22.5%; Cancer negative=23,801, 77.5%). The mean age of all respondents was 46.5 years. A significantly larger proportion of individuals with cancer were older, females, White, married, had health insurance, and were U.S. citizens. Those with cancer were significantly less likely to be smokers or living in poverty. For

Discussion

In this large prospective analysis of a national random sample of adult Americans, elevated CRP was associated with an increased risk (more than two times) of all-cause mortality among people living with cancer. The novelty of this investigation pertains to the assessment of mortality, adjustment for a wide variety of confounders, and consideration of all types of cancers while exploring the relationship between cancer and CRP for long-term outcomes. For the findings of this analysis, there

Conclusions

In this study using NHANES data collected from a multiyear national random sample of community-dwelling American adults, elevated CRP was associated with a more than two times higher risk of mortality among those with a history of cancer. The assessment and monitoring of CRP could be of value among people with cancer as a part of diagnosis, management, and healthcare services follow-up plans given the association of CRP with risk of mortality among cancer patients. Additional longitudinal

Funding

This research received no external funding.

Author contribution

SB, JK, KB, MG conceptualized and designed the study. SB and JK conducted all analysis. ST, MG, and KB drafted the manuscript. ST, MG and JK provided critical inputs on multiple drafts. All authors agree to the final version of the paper submitted.

CRediT authorship contribution statement

Jagdish Khubchandani: Writing – review & editing, Writing – original draft, Validation, Methodology, Investigation, Formal analysis. Shalika Tisinger: Writing – review & editing, Writing – original draft, Methodology, Data curation. Srikanta Banerjee: Writing – original draft, Formal analysis, Data curation, Conceptualization. Kavita Batra: Writing – review & editing, Writing – original draft, Visualization, Validation, Investigation. Maribeth B. Greenway: Writing – review & editing,

Declaration of Competing Interest

The authors have no conflicts of interest to disclose for this manuscript and the study conducted for the manuscript.

References (33)M. Jovani et al.Cardiovascular disease related circulating biomarkers and cancer incidence and mortality: is there an association?

Cardiovasc. Res.

(2022)

K. Heikkilä et al.A systematic review of the association between circulating concentrations of C reactive protein and cancer

J. Epidemiol. Community Health

(2007)

C.C. Van’t Klooster et al.The relation between systemic inflammation and incident cancer in patients with stable cardiovascular disease: a cohort study

Eur. Heart J.

(2019)

S. Shrotriya et al.C-reactive protein is an important biomarker for prognosis tumor recurrence and treatment response in adult solid tumors: a systematic review

PloS One

(2015)

K.H. Allin et al.Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer

Crit. Rev. Clin. Lab. Sci.

(2011)

G. Wang et al.A prospective follow-up study of the relationship between C-reactive protein and human cancer risk in the Chinese Kailuan Female Cohort

Cancer Epidemiol. Biomark. Prev.

(2015)

View full text

© 2024 Elsevier Ltd. All rights reserved.