Comparative associations of immune-inflammatory, immune-lipid, and metabolic composite indices with hyperuricemia among Chinese adults with glycemic abnormalities: a health examination-based cross-sectional study

Abstract

Background Hyperuricemia (HUA) commonly coexists with glycemic abnormalities and may reflect complex metabolic disturbances involving inflammation, lipid dysregulation, insulin resistance, and impaired renal urate handling. However, evidence directly comparing immune-inflammatory, immune–lipid, and metabolic composite indices in relation to HUA among individuals with glycemic abnormalities remains limited. This study aimed to compare the associations of these composite indices with HUA among Chinese adults with glycemic abnormalities. Methods This large-sample health examination-based cross-sectional study included 10, 089 Chinese adults with glycemic abnormalities, of whom 2, 735 had HUA. Immune-inflammatory indices, immune–lipid indices, and metabolic composite indices were calculated using routine laboratory and anthropometric parameters. Multi variable logistic regression models were used to evaluate the associations between each standardized composite index and HUA. Restricted cubic spline analyses were performed to explore nonlinear associations, and subgroup analyses were conducted according to sex, age, BMI, hypertension, fatty liver disease, smoking status, alcohol drinking, glycemic status and eGFR. Results Among participants with glycemic abnormalities, those with HUA showed more pronounced immune–lipid and metabolic abnormalities than those without HUA. In primary multivariable-adjusted model, immune–lipid indices, including WHR, NHR, LHR, MHR, and PHR, were all positively associated with HUA. Among metabolic indices, AIP showed the strongest association with HUA, followed by TyG, METS-IR, and CHG, whereas RC and NHHR were not significantly associated with HUA in the primary multivariable-adjusted model. Among traditional immune-inflammatory indices, SIRI and PIV remained positively associated with HUA, while PLR showed an inverse association and NLR, MLR, and SII were not significant. Restricted cubic spline analyses revealed nonlinear and threshold-dependent associations for several immune–lipid and metabolic indices, with HUA odds increasing at lower-to-moderate levels and then tending to plateau or attenuate at higher levels. Among demographic and anthropometric characteristics, sex, age, and BMI were the most prominent effect modifiers, with generally stronger associations observed in women, participants aged <60 years, and those with BMI <24 kg/m². Conclusions Among Chinese adults with glycemic abnormalities, all three categories of indices were associated with HUA. Among the metabolic composite indices, AIP showed the strongest association with HUA, while TyG, METS-IR, and CHG were also positively associated with HUA. Immune–lipid indices, including WHR, NHR, LHR, MHR, and PHR, showed consistent positive associations with HUA, whereas among conventional immune-inflammatory indicators, PLR, PIV, and SIRI were associated with HUA.