A prospective study on C-reactive protein as a prognostic factor for survival time of terminally ill cancer patients

Abstract

C-reactive protein (CRP) has been investigated as a predictor of life expectancy in terminal cancer in one previous study. However, the other variables such as patient's symptom or physical examination findings were not considered. The aim of this study is to prove serum CRP level as a predictor of survival time, considering patient's symptoms, physical examination findings, and various serological variables in terminally ill cancer patients with a prospective cohort design. Forty-four terminally ill cancer patients were divided into two groups by serum CRP levels and followed up until death. We adjusted the influence of some clinical and laboratory variables on survival by use of Cox's proportional hazard model. Using the stepwise variable selection method, we found the final model. For 19 patients, CRP levels at 2 weeks and a week before death were compared by Wilcoxon signed ranks test. All 44 study subjects died during the study period, and the median survival time was 17 days. Survival time of the elevated CRP group (> or =2.2 mg/dl) was found to be significantly shorter than the lower CRP group in univariate analysis (hazard rate = 3.221, P = 0.001). In multivariate analysis, elevated CRP level (> or =2.2 mg/dl) was selected as one of the unfavorable indicators regarding survival. Dyspnea and hyperbilirubinemia were also found significant predictors of shorter life expectancy in the final model. Serum CRP levels were significantly increased between the first and the second week before death. Our results showed that serum CRP level can be a useful indicator predictive of survival time of terminally ill cancer patients.