Systemic inflammation-based Glasgow Prognostic Score as a prognostic indicator in chronic heart failure

Abstract

Background: The Glasgow Prognostic Score (GPS), based on C-reactive protein and serum albumin concentrations provides useful prognostic information for patients with cancer or acute decompensated heart failure (HF). Herein, we aimed to evaluate the relationship between the GPS and long-term prognosis in patients with chronic HF.

Methods: In this large multicentre prospective observational study, part of the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study, we analysed the relationship between mortality and the GPS in 6,480 patients with chronic HF (mean age, 68 ± 13 years; 69 % male). Patients with elevated C-reactive protein levels (>1.0 mg/dL) and hypoalbuminaemia (<3.5 g/dL) received a GPS of 2; those with either received a GPS of 1, and those with neither received a GPS of 0.

Results: During median follow-up of 9.62 years, 2,564 patients (39.6 %) died. Increased GPS was associated with a significantly higher mortality risk in Kaplan-Meier analysis (log-rank P < 0.0001). This trend was consistent across sex, age, New York Heart Association class, HF stage and type, and cancer history. Adjusted Cox proportional hazards analysis showed the following hazard ratios for all-cause death, relative to a GPS of 0, 1.27 (95 % confidence interval, 1.13-1.44; P < 0.0001) for a GPS of 1 and 1.83 (95 % confidence interval, 1.45-2.32; P < 0.0001) for a GPS of 2. This increased risk was independent of B-type natriuretic peptide levels.

Conclusions: The GPS, which reflects systemic inflammation status, is a useful predictor of long-term prognosis in patients with chronic HF.

Keywords: Albumin; C-reactive protein; Chronic heart failure; Glasgow Prognostic Score; Mortality.

Graphical abstract

Fig. 1

Kaplan–Meier curves for all-cause death in patients with a GPS of 0, 1, and 2. GPS, Glasgow Prognostic Score.

Fig. 2

Forest plot showing the risks for all-cause death of patients with a GPS of 1 relative to those with a GPS of 0. GPS, Glasgow Prognostic Score; NYHA, New York Heart Association; HF, heart failure; HFrEF, heart failure with reduced left ventricular ejection fraction; HFmrEF, heart failure with mildly reduced left ventricular ejection fraction; HFpEF, heart failure with preserved left ventricular ejection fraction.

Fig. 3

Forest plot showing the risks for all-cause death of patients with a GPS of 2 relative to those with a GPS of 0. In patients with NYHA IV, the hazard ratio is 10.1, with a 95% CI of 2.69–38.3. The upper limit of the CI has been set to 10 in this figure to improve readability. CI, confidence interval; GPS, Glasgow Prognostic Score; NYHA, New York Heart Association; HF, heart failure; HFrEF, heart failure with reduced left ventricular ejection fraction; HFmrEF, heart failure with mildly reduced left ventricular ejection fraction; HFpEF, heart failure with preserved left ventricular ejection fraction.