Trajectories of metabolic and inflammatory biomarkers ten years before cancer diagnosis and the risk of subsequent severe infections: a Swedish population-based cohort study

BackgroundBlood-based metabolic and inflammatory biomarker levels prior to diagnosis might be associated with the risk of severe infections among cancer patients. ObjectivesTo investigate the longitudinal trajectories of circulating metabolic and inflammatory biomarkers before cancer diagnosis and assess their associations with the risk of severe infections after cancer diagnosis. MethodsWe conducted a cohort study including 10,837 patients with a first diagnosis of cancer during 1985-2005 within the Swedish AMORIS (Apolipoprotein-related MOrtality RISk) cohort. Severe infections were identified as a hospitalization for infectious diseases or a diagnosis of sepsis after cancer diagnosis throughout December 31, 2020. We focused on 18 biomarkers to identify biomarker trajectories during the 10 years before cancer diagnosis using latent class growth modeling. Through flexible parametric models, we then visualized and calculated hazards and hazard ratios (HRs) with 95% confidence intervals (CIs) of severe infections after cancer diagnosis in relation to different biomarker trajectories. ResultsThe included patients had a mean (SD) age at diagnosis of 65.9 (11.7), including 5476 men (50.5%) and 9385 who were born in Sweden (86.6%). A total of 3752 (34.6%) patients were hospitalized for infectious diseases whereas 1709 (15.8%) had a diagnosis of sepsis after cancer diagnosis. We identified several distinct trajectories for the selected biomarkers during the 10 years before cancer diagnosis. A 25% to 65% higher hazard of hospitalization for infectious diseases was observed in patients with persistently high levels of glucose [HR (95%CI): 1.54 (1.34-1.78)], fructosamine [1.65 (1.38-1.97)], or triglycerides [1.25 (1.13-1.37)], compared to patients with persistently low levels. An opposite trend was however noted for total cholesterol and high-density lipoprotein. Further, compared to patients with persistently low levels, patients with increasing levels of C-reactive protein [1.25 (1.10-1.43)] and immunoglobulin G [1.85 (1.24-2.76)] had an increased risk of hospitalization for infectious diseases after cancer diagnosis. Similar results were observed for sepsis. ConclusionTemporal trajectories in metabolic and inflammatory biomarkers during the 10 years before cancer diagnosis were linked to an altered risk of severe infections after cancer diagnosis. Longitudinal measurement of these biomarkers before cancer diagnosis, may therefore help provide a more comprehensive assessment of the risk for severe infections among cancer patients.