Lipids & metabolic liver disease
Association of the C-reactive protein–triglyceride glucose index with all-cause and cardiovascular mortality among U.S. adults with metabolic dysfunction-associated steatotic liver disease: a national cohort study
Authors' conclusion
Elevated CTI values are significantly associated with increased ACM and CVM among MASLD patients.
Study context
- Population
- US adults with MASLD in NHANES (1999–2010, 2015–2018)
- Participants
- 5,029 adults
- Exposure
- Highest vs lowest CTI quartile
- Outcome
- All-cause mortality and cardiovascular mortality
- Follow-up
- Median 122 months
Methodological detailsnational cohort, NHANES 1999-2010, 2015-2018, multivariate Cox proportional hazards models, restricted cubic spline analyses
- National cohort
- NHANES 1999-2010, 2015-2018
- Multivariate Cox proportional hazards models
- Restricted cubic spline analyses
Main finding
As reported in the abstract
Highest CTI quartile vs Lowest CTI quartileHazard ratio (95% CI)P value
All-cause mortality
1.86(1.50–2.31)
P < 0.001Cardiovascular mortality
2.07(1.44–2.97)
P < 0.001- All-cause deaths
- 1,072
- Cardiovascular deaths
- 352
Observational data: associations, not effects.
Further findings
Dose-response (restricted cubic spline)
- Significant nonlinear relationship; mortality risk rising sharply above CTI value
- 8.8
Subgroups
- Significant interactions with age and fibrosis-4 index; stronger associations in participants <60 years and with lower fibrosis-4 scores
Mediation of CTI–all-cause mortality link (exploratory)
- Neutrophils, mediation proportion
- 16%
- HbA1c, mediation proportion
- 33%
Discrimination
- Adding CTI to a conventional risk model gave the greatest improvement in discrimination for all-cause and CV mortality vs CRP or TyG index alone
Sensitivity analyses
- Sensitivity analyses supported the robustness of the results
Original publication
Association of the C-reactive protein–triglyceride glucose index with all-cause and cardiovascular mortality among U.S. adults with metabolic dysfunction-associated steatotic liver disease: a national cohort study. Cardiovasc Diabetol. Published 1 April 2026. doi:10.
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