Associations Between High-Sensitivity C-Reactive Protein and All-Cause Mortality Among Oldest-Old in Chinese Longevity Areas: A Community-Based Cohort Study.

Pei-Liang Chen,Xi-Ru Zhang,Xian-Bo Wu,Xiao-Ming Shi,Zhao-Jin Cao,Hai-Lian Yang,Fu-Rong Li,Ling Liu,Zhi-Hao Li,Chen Mao,Xin Cheng,Ying-Li Qu,Yuan-Feng Zhou,Hao-Nan Li,Feng Zhao,Zhao-Xue Yin,Yue-Bin Lv

doi:10.3389/fpubh.2022.824783

Abstract

BackgroundThe association between high-sensitivity C-reactive protein (hsCRP) levels and all-cause mortality for the oldest-old (aged 80 years or older) remains unclear. We aimed to investigate the associations between hsCRP concentrations and the risks of all-cause mortality, and further identify the potential modifying factors affecting these associations among the oldest-old.MethodsThis prospective, community-based cohort study included 2,206 participants aged 80 years or older (median age 93.0 years) from the Healthy Aging and Biomarkers Cohort Study. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (95% CIs) for all-cause mortality according to hsCRP quartiles and recommendation for relative risk categories of hsCRP levels (< 1.0, 1.0–3.0, and > 3.0 mg/L), with adjustment for sociodemographic information, lifestyle, physical examination, medical history, and other potential confounders.ResultsDuring a median follow-up period of 3.1 years (IQR: 1.6–3.9 years), 1,106 deaths were verified. After full adjustment for potential confounders, a higher hsCRP concentration was positively associated with an increased risk of all-cause mortality (P for trend < 0.001). Compared with the lowest quartile, the fully adjusted HRs of the second, third, and fourth quartiles were 1.17 (95% CI: 0.94, 1.46), 1.28 (95% CI: 1.01, 1.61), and 1.49 (95% CI: 1.20, 1.87), respectively. The association of hsCRP with all-cause mortality was modified by smoking status (P for interaction = 0.011), an increased risk of hsCRP with all-cause mortality showed among non-current smokers (HR: 1.17; 95% CI: 1.07, 1.28), but no significance was observed in current smokers (HR: 0.83; 95% CI: 0.66, 1.18).ConclusionsOur study indicated that elevated hsCRP concentrations were associated with a higher risk of all-cause mortality among Chinese oldest-old. Future studies investigating additional factors of disease and aging processes are needed to obtain a better understanding of the mechanisms.

Highlights

The association between high-sensitivity C-reactive protein levels and all-cause mortality for the oldest-old remains unclear
The risk of all-cause mortality increased with elevated high-sensitivity C-reactive protein (hsCRP) (P < 0.001). Compared to those with hsCRP 3.0 mg/L had a significantly higher risk (HR: 1.39; 95% confidential interval (CI): 1.14, 1.70) of all-cause mortality even after full adjustment
A significant interaction from smoking status was noted (P = 0.011), where an increased risk of hsCRP with all-cause mortality showed among non-current smokers (HR: 1.17; 95% confidential intervals (95% CIs): 1.07, 1.28), but no significance was observed in current smokers (HR: 0.83; 95% CI: 0.66, 1.18)

Summary

Introduction

The association between high-sensitivity C-reactive protein (hsCRP) levels and all-cause mortality for the oldest-old (aged 80 years or older) remains unclear. Low-grade elevations in markers of inflammation, such as high-sensitivity C-reactive protein (hsCRP), are potent risk factors for all-cause mortality [9]. Inconsistent results may exist due to sex, ethnic or age differences in the populations, and the strength of the association varied across studies, from 1.14 to 3.64 (hazard ratios or relative risks). These findings are based on the general population, but the oldest old adults (octogenarians, non-agenarians, and centenarians) remain underrepresented. The classic risk markers for disease and mortality might not be suitable in the oldest old population [30]

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