High-sensitivity Glasgow prognostic score and infection-related mortality in maintenance hemodialysis patients: 10-year outcomes of the Q-Cohort Study.

BACKGROUND

Infection is a major cause of death in patients undergoing maintenance hemodialysis (HD). We examined whether the high-sensitivity Glasgow prognostic score (hsGPS), derived from serum C-reactive protein (CRP) and albumin, is associated with infection-related mortality.

METHODS

This retrospective cohort study included 3529 patients undergoing maintenance HD enrolled between December 31, 2006 and December 31, 2007 and followed until December 31, 2016. We used a high-sensitivity Glasgow prognostic score (hsGPS), defined using a lower CRP threshold in a GPS-type manner as follows: score 0, CRP ≤ 0.3 mg/dL and albumin ≥ 3.5 g/dL; score 1, CRP > 0.3 mg/dL or albumin < 3.5 g/dL; and score 2, CRP > 0.3 mg/dL and albumin < 3.5 g/dL. Associations were evaluated using Kaplan-Meier analysis, Cox proportional hazards models, Fine-Gray competing-risk models, and restricted cubic spline analyses.

RESULTS

During a median follow-up of 3199 days, 1748 deaths occurred, including 451 infection-related deaths. In descriptive Kaplan-Meier analysis, infection-related death-free survival was lower in higher hsGPS groups. In the multivariable-adjusted Cox model, hazard ratios for infection-related mortality were 1.79 (95% confidence interval [CI] 1.43-2.24) for hsGPS 1 and 2.38 (95% CI 1.71-3.31) for hsGPS 2, compared with hsGPS 0. Competing-risk analyses showed similar trends, although the associations were attenuated. Restricted cubic spline analyses showed higher risk at lower albumin levels and higher CRP levels.

CONCLUSIONS

Higher hsGPS was associated with higher infection-related mortality in patients undergoing maintenance HD. hsGPS may serve as a simple risk stratification tool in this population.