Systemic Inflammation Is Associated With Future Risk of Fatal Infection: An Observational Cohort Study

Systemic inflammation assessed using C-reactive protein is common in many chronic diseases and is associated with increased long-term risk of fatal infection. This may contribute to the observed risks of fatal infection in recipients of anti-inflammatory therapies. Background Many diseases are associated with chronic inflammation, resulting in widening application of anti-inflammatory therapies. Although they are effective as disease-modifying agents, these anti-inflammatory therapies increase the risk of serious infection; however, it remains unknown whether chronic systemic inflammation per se is also associated with fatal infection. Methods Using serum C-reactive protein (CRP) data from 461 052 UK Biobank participants, we defined incidence rate ratios (IRRs) for death from infection, cardiovascular disease, or other causes and adjusted for comorbidities and the use of anti-inflammatory therapies. Results Systemic inflammation, defined as CRP >= 2 mg/L, was common in all comorbidities considered. After adjusting for confounding factors, systemic inflammation was associated with a higher IRR point estimate for infection death (1.70; 95% confidence interval [CI], 1.51-1.92) than cardiovascular (1.48; CI, 1.40-1.57) or other death (1.41; CI, 1.37-1.45), although CIs overlapped. C-reactive protein thresholds of >= 5 and >= 10 mg/L yielded similar findings, as did analyses in people with >= 2, but not <2, comorbidities. Conclusions Systemic inflammation per se identifies people at increased risk of infection death, potentially contributing to the observed risks of anti-inflammatory therapies in clinical trials. In future clinical trials of anti-inflammatory therapies, researchers should carefully consider risks and benefits in target populations, guided by research into mechanisms of infection risk.