Association between the C-reactive protein–triglyceride glucose index and postoperative acute kidney injury after elective abdominal surgery: a retrospective cohort study
- 1epartment of Anesthesiology, Weifang People’s Hospital, Weifang, China
Abstract
BackgroundPostoperative acute kidney injury (PO-AKI) is a common and serious complication following abdominal surgery and is strongly associated with poor prognosis. Traditional diagnostic markers lack sensitivity. The novel C-reactive protein–triglyceride glucose index (CTI) has emerged as an innovative composite marker for evaluating metabolic-inflammatory dysregulation, comprehensively integrating markers of insulin resistance and systemic inflammation. However, its relationship with PO-AKI risk remains unclear.MethodsThis single-center retrospective study included adult patients who underwent elective major abdominal surgery between April 2020 and April 2025. The preoperative CTI was the primary exposure variable. The primary outcome was the incidence of AKI within 7 days post-surgery, defined according to the KDIGO creatinine criteria. Multivariable logistic regression was used to assess the association between CTI and PO-AKI, and restricted cubic splines (RCS) were applied to examine dose–response relationships. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive performance of CTI and the TyG index for PO-AKI. Subgroup analyses and sensitivity analyses were conducted to evaluate the robustness of the findings.ResultsA total of 4,658 patients were included, of whom 222 (4.77%) developed PO-AKI. After full adjustment for confounders, higher CTI was significantly associated with increased PO-AKI risk (OR = 1.28, 95% CI: 1.09–1.52). Compared with patients in the lowest CTI quartile, those in the highest quartile had a significantly higher risk (OR = 1.86, 95% CI: 1.12–3.11). RCS analysis revealed a linear positive association between CTI and PO-AKI. The area under the ROC curve (AUC) for CTI was significantly greater than that for the TyG index alone (0.643 vs. 0.587; P = 0.0003). Moreover, CTI values above approximately 9.5 were associated with prolonged postoperative hospital stay.ConclusionsThe preoperative CTI, a surrogate marker for the systemic immuno-metabolic phenotype, is an independent risk factor for PO-AKI after abdominal surgery. Notably, a CTI threshold of 9.5 serves as a cclinical decision node, offering superior predictive value for prolonged care trajectories and informing targeted perioperative prehabilitation strategies.
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BibTeX
@article{zhong2026association,
title = {{Association between the C-reactive protein–triglyceride glucose index and postoperative acute kidney injury after elective abdominal surgery: a retrospective cohort study}},
author = {Yu qi Zhong and Binbin Wang and Xiuxia Gu and Rui Zhang and Fangli Yue and Yajuan Zhao},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1933511},
url = {https://doi.org/10.3389/fmed.2026.1933511},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association between the C-reactive protein–triglyceride glucose index and postoperative acute kidney injury after elective abdominal surgery: a retrospective cohort study
AU - Yu qi Zhong
AU - Binbin Wang
AU - Xiuxia Gu
AU - Rui Zhang
AU - Fangli Yue
AU - Yajuan Zhao
PY - 2026
DA - 2026/10/26
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1933511
UR - https://doi.org/10.3389/fmed.2026.1933511
AB - BackgroundPostoperative acute kidney injury (PO-AKI) is a common and serious complication following abdominal surgery and is strongly associated with poor prognosis. Traditional diagnostic markers lack sensitivity. The novel C-reactive protein–triglyceride glucose index (CTI) has emerged as an innovative composite marker for evaluating metabolic-inflammatory dysregulation, comprehensively integrating markers of insulin resistance and systemic inflammation. However, its relationship with PO-AKI risk remains unclear.MethodsThis single-center retrospective study included adult patients who underwent elective major abdominal surgery between April 2020 and April 2025. The preoperative CTI was the primary exposure variable. The primary outcome was the incidence of AKI within 7 days post-surgery, defined according to the KDIGO creatinine criteria. Multivariable logistic regression was used to assess the association between CTI and PO-AKI, and restricted cubic splines (RCS) were applied to examine dose–response relationships. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive performance of CTI and the TyG index for PO-AKI. Subgroup analyses and sensitivity analyses were conducted to evaluate the robustness of the findings.ResultsA total of 4,658 patients were included, of whom 222 (4.77%) developed PO-AKI. After full adjustment for confounders, higher CTI was significantly associated with increased PO-AKI risk (OR = 1.28, 95% CI: 1.09–1.52). Compared with patients in the lowest CTI quartile, those in the highest quartile had a significantly higher risk (OR = 1.86, 95% CI: 1.12–3.11). RCS analysis revealed a linear positive association between CTI and PO-AKI. The area under the ROC curve (AUC) for CTI was significantly greater than that for the TyG index alone (0.643 vs. 0.587; P = 0.0003). Moreover, CTI values above approximately 9.5 were associated with prolonged postoperative hospital stay.ConclusionsThe preoperative CTI, a surrogate marker for the systemic immuno-metabolic phenotype, is an independent risk factor for PO-AKI after abdominal surgery. Notably, a CTI threshold of 9.5 serves as a cclinical decision node, offering superior predictive value for prolonged care trajectories and informing targeted perioperative prehabilitation strategies.
SN - 2296-858X
ER -