Dose-response association between C-reactive protein and risk of all-cause and cause-specific mortality: a systematic review and meta-analysis of cohort studies

The purpose of the study is to quantitatively assess the association between C-reactive protein (CRP) and all-cause, cardiovascular disease (CVD), and cancer mortality; a dose-response meta-analysis was performed on data from cohort studies in general population. The published relevant articles were searched for in PubMed, Web of Science, and Embase until September 21, 2019. The pooled relative risk (RR) was estimated by random effects of generalized least square regression models. The dose-response relationship was modeled using restricted cubic splines. Twenty-two articles were screened for the meta-analysis. Compared with the low CRP group, the pooled RR in the moderate CRP group was 1.30 (95% confidence interval (CI), 1.20–1.41) for all-cause mortality and 1.43 (95% CI, 1.22–1.68) for CVD mortality; the pooled RR in the high CRP group was 1.75 (95% CI, 1.59–1.92) for all-cause mortality, 2.02 (95% CI, 1.70–2.41) for CVD mortality, and 1.32 (95% CI, 1.21–1.45) for cancer mortality. This meta-analysis demonstrated the relationships between CRP and mortality were nonlinear for all-cause and CVD mortality and were linear for cancer and noncardiovascular mortality. •The dose-response relationship between CRP and all-cause mortality is nonlinear.•The dose-response relationship between CRP and CVD mortality is nonlinear.•The dose-response relationship between CRP and cancer mortality is linear.•The dose-response relationship between CRP and non-CVD mortality is linear.