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Abstract
Objectives Identification of patients at increased mortality risk is important in the context of increasing multimorbidity and an ageing population, to help facilitate the planning and delivery of services. The aim of this study was to examine 1-year all-cause mortality in a cohort of primary care patients in whom inflammatory markers including C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and plasma viscosity (PV), had been tested.
Design Observational cohort study using general practitioner Electronic Health Records from the Clinical Practice Research Datalink, with linkage to Office for National Statistics (ONS) Death Registry.
Setting UK Primary Care.
Participants 159 325 patients with inflammatory marker tests done in 2014 and 39 928 age, sex and practice-matched controls without inflammatory marker testing. ONS Death registry data were available for 109 966 participants.
Primary and secondary outcome measures One-year mortality in those with raised inflammatory markers compared with normal inflammatory markers and untested controls. Subanalyses stratified 1-year mortality by age group, gender and cause of death.
Results Patients with a raised inflammatory marker (n=47 797) had an overall 1-year all-cause mortality of 6.89%, compared with 1.41% in those with normal inflammatory markers (p<0.001) and 1.62% in untested controls. A raised CRP is associated with the highest mortality rate at 8.76% compared with 4.99% for ESR and 4.66% for PV. One-year mortality is higher in men with a raised inflammatory marker compared with women (9.78% vs 5.29%). The C-statistic of a simple mortality prediction model containing age, sex and CRP test result is 0.89.
Conclusions Inflammatory markers are a strong predictor of all-cause mortality in primary care, with a C-statistic comparable to several previously developed frailty indices. Future research should consider the added value of CRP testing, in combination with other risk factors, to improve prediction of mortality in primary care. Evidence- based interventions for frailty are needed alongside predictive tools.
- primary care
- epidemiology
- chemical pathology
- geriatric medicine
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Footnotes
Twitter @drjessicawatson
Contributors WH, CS, PW, JB and JW all contributed to conception, design and planning of the study. JW analysed the data as part of her Doctoral Research Fellowship, with oversight of the conduct of the study provided by her PhD supervisors WH, CS, PW and JB. JW wrote the first draft of the paper. WH, CS, PW, JB and JW all contributed to subsequent drafts and read and approved the final manuscript.
Funding This report is independent research arising from JW’s Doctoral Research Fellowship (DRF-2016-09-034) supported by the National Institute for Health Research. JB, PW, CS and JW were supported by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West). CS is an NIHR Senior Investigator.
Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health and Social Care.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by the Independent Scientific Application Committee for MHRA database research (ISAC) protocol number 17_003. The protocol is available at: https://www.cprd.com/protocol/diagnostic-utility-inflammatory-markers-primary-care-prospective-cohort-study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement This study is based on data from the Clinical Practice Research Datalink (CPRD) obtained under licence from the UK Medicines and Healthcare products Regulatory Agency, which does not permit data shaing. The data are provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the authors alone.
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