Associations between C-reactive protein-triglyceride glucose index combined with anthropometric indices and mortality risk in individuals with cardiovascular-kidney-liver-metabolic syndrome: a national cohort study

Background C-reactive protein-triglyceride glucose index (CTI) combined with anthropometric indices serve as integrative markers of insulin resistance, inflammation, and visceral obesity, exerting a detrimental effect on prognosis. However, the prognostic significance of CTI-anthropometric indices in individuals with cardiovascular-kidney-liver-metabolic (CKLM) syndrome remains uncertain. This study was conducted to elucidate the relationships between the CTI-anthropometric indices and mortality risk in this population. Methods This study included 14,203 individuals with CKLM syndrome from the National Health and Nutrition Examination Survey (NHANES, 1999–2018). Kaplan–Meier curve analyses, Cox proportional hazards models, Fine-Gray competing risk models, and restricted cubic spline (RCS) models were performed to evaluate the relationships of CTI-anthropometric indices with cardiovascular mortality and all-cause mortality. Receiver operating characteristic (ROC) curves were used to compare the predictive performance of CTI-anthropometric indices. Subgroup and sensitivity analyses were conducted to verify the robustness of the results. Results During a median follow-up period of 11.42 years, there were 772 cardiovascular deaths and 2,424 all-cause deaths. Kaplan‒Meier curve analyses indicated the lowest survival rate in the highest quartile of CTI-anthropometric indices (Log-rank p < 0.001). Multivariable Cox regression analyses revealed that CTI-anthropometric indices in the highest quartile were associated with an increased risk of cardiovascular mortality and all-cause mortality, compared with the lowest quartile. The Fine-Gray competing risk models also demonstrated that CTI-anthropometric indices were independently associated with cardiovascular mortality. The RCS results showed a linear or non-linear association of CTI-anthropometric indices with cardiovascular mortality and all-cause mortality. ROC curve analyses indicated that CTI-a body shape index (CTI-ABSI) exhibited preferred predictive performance for mortality risk at 1-, 5-, and 10-year time points compared to other CTI-anthropometric indices. Subgroup and sensitivity analyses confirmed the robustness of the results of CTI-ABSI. Conclusion Elevated CTI-anthropometric indices were independently associated with increased mortality risk in individuals with CKLM syndrome, with CTI-ABSI emerging as the preferred predictor of mortality risk. These findings provide an approach for enhancing risk discrimination and stratification in individuals with CKLM syndrome. Clinical trial number Not applicable.