Associations of C-reactive protein-triglyceride glucose-related indices with mortality across glycemic states: a nationwide prospective cohort study.

Background

The associations and comparative discrimination of indices integrating inflammation, insulin resistance, and body shape within glycemic-status strata remain uncertain.

Methods

We included 13,867 adults from the 1999-2010 and 2015-2018 National Health and Nutrition Examination Survey. Complex-survey weighted Cox models evaluated CTI, CTI-BMI, CTI-BRI, CTI-WWI, CTI-ABSI, and CTI-WHtR continuously and by weighted quartiles in participants with normal glycemia, abnormal glycemia, or diabetes. Restricted cubic splines, time-dependent receiver operating characteristic curves, interaction tests, and sensitivity analyses were performed.

Results

During follow-up, 2,197 all-cause and 687 cardiovascular deaths occurred. Among participants with abnormal glycemia, the hazard ratios per weighted standard deviation for CTI-ABSI were 1.21 (95 % CI, 1.10-1.34) for all-cause mortality and 1.43 (95 % CI, 1.18-1.73) for cardiovascular mortality. Corresponding estimates for CTI-WWI were 1.19 (95 % CI, 1.07-1.33) and 1.49 (95 % CI, 1.20-1.85). CTI-ABSI and CTI-WWI had relatively higher single-marker AUCs in several analyses, but incremental improvements beyond clinical factors were small. Glycemic-status interactions were not statistically significant.

Conclusions

Several CTI-related indices were associated with mortality within glycemic-status strata. However, the findings do not establish effect modification, group-specific applicability, or validated clinical utility. These indices should be considered epidemiological markers.