Prognostic stratification with composite insulin resistance–inflammation biomarkers in patients with chronic kidney disease and coronary artery disease across glycemic statuses
Authors' conclusion
Composite biomarkers integrating IR and inflammation, particularly CTI, significantly enhance mortality prediction in patients with CKD and CAD. The predictive utility is modulated by underlying glycemic status, enabling refined risk stratification and potentially guiding tailored management strategies for this complex patient population.
Study context
- Population
- Patients with chronic kidney disease (CKD) and coronary artery disease, National Health and Nutrition Examination Survey (NHANES) 1999–2018; categorized as normoglycemia, prediabetes or diabetes (WHO/IEC criteria)
- Participants
- 1,353 patients
- Exposure
- Higher vs lower composite insulin resistance (IR)-inflammation biomarkers (TyG-hsCRP, TyG-CRP, CTI), stratified by glycemic status
- Outcome
- All-cause and CVD death
- Follow-up
- Median 63 months
Methodological detailsNHANES 1999-2018, adjusted Cox regression
- NHANES 1999-2018
- Adjusted Cox regression
Main finding
As reported in the abstract
CTIHazard ratio (95% CI)
All-cause mortality; adjusted
1.43(1.24–1.65)
CVD mortality; adjusted
1.32(1.06–1.64)
- All-cause deaths
- 744
- Cardiovascular disease (CVD) deaths
- 323
Observational data: associations, not effects.
Further findings
Diabetes and high CTI (combined stratification)
| HR (CI) | ||
|---|---|---|
| Diabetes + high CTIAll-cause death; highest risk | 1.63 (1.22–2.17) | |
| Diabetes + high CTICVD death | 1.37 (0.88–2.14) | |
| 0.512Hazard ratio (log scale) |
Discrimination and reclassification of CTI (all-cause)
- AUC
- 0.700
- IDI
- 0.010
- NRI
- 0.196
By glycemic status
- Predictive utility of all three biomarkers most pronounced in diabetes; CTI retained strong association with all-cause mortality in normoglycemia and prediabetes
Original publication
Prognostic stratification with composite insulin resistance–inflammation biomarkers in patients with chronic kidney disease and coronary artery disease across glycemic statuses. Cardiovasc Diabetol. Published 2 March 2026. doi:10.
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