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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Association between C-reactive protein-triglyceride-glucose index and one-year all-cause mortality in patients with cardiometabolic multimorbidity

  • Zhongyuan Zhang1
  • Chaoqun Xu1
  • Lili Huo2
  • Haitao He1
  • Lanting Li3
  • Songtao Feng4
  • Aibin Tao1
4 affiliations
  1. 1Department of Cardiology, The Affiliated People’s Hospital of Jiangsu University
  2. 2Information Technology Center, The Affiliated People’s Hospital of Jiangsu University
  3. 3Department of Cardiology, Zhenjiang School of Clinical Medicine, Nanjing Medical University
  4. 4Department of Nephrology, The Affiliated People’s Hospital of Jiangsu University
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Abstract

Introduction: Cardiometabolic multimorbidity (CMM) is increasingly prevalent among middle-aged and older adults. The C-reactive protein-triglyceride glucose index (CTI), a novel biomarker integrating inflammation and insulin resistance (IR), has been linked to CMM prevalence and incidence. However, its association with all-cause mortality in CMM patients remains unclear. This study aimed to investigate the relationship between CTI and one-year mortality in CMM patients.

Methods: The retrospective-prospective cohort study enrolled 7,220 participants between January 2022 and December 2024. The primary endpoint was all-cause mortality within 365 days of admission. Mortality was verified in January 2026 through electronic medical record (EMR) review and telephone follow-up, with no loss to follow-up. Patients were categorized into four groups according to the quartiles of the CTI. We employed least absolute shrinkage and selection operator (LASSO) regression to identify key predictors. Cox proportional hazards models, Kaplan–Meier curves, restricted cubic spline analyses, and ROC curves were employed to evaluate the associations of CTI with the mortality in CMM patients. Additionally, subgroup analyses were conducted to explore potential effect modifiers.

Results: This study included 7,220 individuals with CMM. During the one-year follow-up, 537 (7.44%) deaths occurred, with elevated CTI levels showing a significant association with increased risks of all-cause mortality. Per 1-SD increase in CTI corresponded to a 17% higher mortality risk (HR = 1.17, 95% CI 1.07–1.29), while patients in the highest CTI quartile exhibited a 75% elevated risk vs. the lowest quartile (HR = 1.75, 95% CI 1.30–2.37). Our results suggested a positive association between CTI and CMM mortality, with risk increasing from Q1 to Q3 and plateauing in Q4. Additionally, CTI alone yielded an AUC of 0.639, the base model yielded an AUC of 0.828; the addition of CTI increased the AUC to 0.833.

Conclusion: Our analysis revealed that elevated CTI levels were significantly associated with all-cause mortality in CMM patients. As a clinically practical marker, CTI may serve as an exploratory risk-stratification marker in CMM patients and its clinical utility remains to be confirmed in prospective studies.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026association,
  title = {{Association between C-reactive protein-triglyceride-glucose index and one-year all-cause mortality in patients with cardiometabolic multimorbidity}},
  author = {Zhongyuan Zhang and Chaoqun Xu and Lili Huo and Haitao He and Lanting Li and Songtao Feng and Aibin Tao},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = nov,
  doi = {10.3389/fcvm.2026.1889357},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1889357/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Association between C-reactive protein-triglyceride-glucose index and one-year all-cause mortality in patients with cardiometabolic multimorbidity
AU  - Zhongyuan Zhang
AU  - Chaoqun Xu
AU  - Lili Huo
AU  - Haitao He
AU  - Lanting Li
AU  - Songtao Feng
AU  - Aibin Tao
PY  - 2026
DA  - 2026/11/04
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1889357
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1889357/full
AB  - Introduction: Cardiometabolic multimorbidity (CMM) is increasingly prevalent among middle-aged and older adults. The C-reactive protein-triglyceride glucose index (CTI), a novel biomarker integrating inflammation and insulin resistance (IR), has been linked to CMM prevalence and incidence. However, its association with all-cause mortality in CMM patients remains unclear. This study aimed to investigate the relationship between CTI and one-year mortality in CMM patients.  Methods: The retrospective-prospective cohort study enrolled 7,220 participants between January 2022 and December 2024. The primary endpoint was all-cause mortality within 365 days of admission. Mortality was verified in January 2026 through electronic medical record (EMR) review and telephone follow-up, with no loss to follow-up. Patients were categorized into four groups according to the quartiles of the CTI. We employed least absolute shrinkage and selection operator (LASSO) regression to identify key predictors. Cox proportional hazards models, Kaplan–Meier curves, restricted cubic spline analyses, and ROC curves were employed to evaluate the associations of CTI with the mortality in CMM patients. Additionally, subgroup analyses were conducted to explore potential effect modifiers.  Results: This study included 7,220 individuals with CMM. During the one-year follow-up, 537 (7.44%) deaths occurred, with elevated CTI levels showing a significant association with increased risks of all-cause mortality. Per 1-SD increase in CTI corresponded to a 17% higher mortality risk (HR = 1.17, 95% CI 1.07–1.29), while patients in the highest CTI quartile exhibited a 75% elevated risk vs. the lowest quartile (HR = 1.75, 95% CI 1.30–2.37). Our results suggested a positive association between CTI and CMM mortality, with risk increasing from Q1 to Q3 and plateauing in Q4. Additionally, CTI alone yielded an AUC of 0.639, the base model yielded an AUC of 0.828; the addition of CTI increased the AUC to 0.833.  Conclusion: Our analysis revealed that elevated CTI levels were significantly associated with all-cause mortality in CMM patients. As a clinically practical marker, CTI may serve as an exploratory risk-stratification marker in CMM patients and its clinical utility remains to be confirmed in prospective studies.
SN  - 2297-055X
ER  -