The modified cardiometabolic index is associated with gallstones in US adults: a cross-sectional analysis

Figure 1.. Flowchart of the participant selection process. ALT = alanine aminotransferase, CHR = C-reactive protein-to-HDL-C ratio, LDL-C = low-density lipoprotein cholesterol, LHR = lymphocyte-to-HDL-C ratio, MCMI = modified cardiometabolic index, NHANES = National Health and Nutrition Examination Survey, PIR = poverty income ratio.

Figure 2.. Restricted cubic spline analysis of the association between MCMI and prevalent gallstones: (A) unadjusted; (B) adjusted for age, sex, and race/ethnicity; and (C) adjusted for all prespecified covariates. CI = confidence interval, MCMI = modified cardiometabolic index, OR = odds ratio.

Figure 3.. Subgroup analyses of the association between MCMI and prevalent gallstones: (A) unadjusted and (B) fully adjusted. CI = confidence interval, MCMI = modified cardiometabolic index, OR = odds ratio, PIR = poverty income ratio.

Figure 4.. Receiver operating characteristic curves comparing 9 indices for discriminating prevalent gallstones. CHR = C-reactive protein-to-HDL-C ratio, CMI = cardiometabolic index, FIB-4 = fibrosis-4 index, LHR = lymphocyte-to-HDL-C ratio, MCMI = modified cardiometabolic index, MHR = monocyte-to-HDL-C ratio, NHR = neutrophil-to-HDL-C ratio, PHR = platelet-to-HDL-C ratio, TyG = triglyceride-glucose index.

Figure 5.. Boruta algorithm for selecting model variables. (A) Boxplot of feature importance ranking across multiple runs. Green boxes indicate confirmed important variables, yellow boxes indicate tentative variables, red boxes indicate unimportant variables, and blue boxes represent shadow variables. (B) Feature importance trajectories across 100 classifier runs, demonstrating the stability of variable selection over iterations. ALT = alanine aminotransferase, AST = aspartate aminotransferase, LDL-C = low-density lipoprotein cholesterol, MCMI = modified cardiometabolic index, PIR = poverty income ratio, TC = total cholesterol.

Figure 6.. LASSO penalized regression analysis was used to identify factors associated with gallstone risk. (A) The coefficient trajectory for each variable as log lambda changes. (B) LASSO regression cross-validation profile, where each red dot indicates the MSE for each λ value. The dashed line on the left indicates the minimum error (log λ_min) and the dashed line on the right indicates the standard error threshold chosen by the model (log λ_1se). LASSO = least absolute shrinkage and selection operator, MSE = mean squared error.

Figure 7.. Internal performance of the gallstone classification model in the training and test sets. (A) Receiver operating characteristic curve for the training set; (B) receiver operating characteristic curve for the test set; (C) calibration curve for the training set; (D) calibration curve for the test set; (E) DCA for the training set; and (F) DCA for the test set. AUC = area under the curve, CI = confidence interval, DCA = decision curve analysis.

Figure 8.. Nomogram for classifying prevalent gallstones. (A) Nomogram. (B) Receiver operating characteristic curve for the nomogram. Coding: race, 1 = Mexican American, 2 = other Hispanic, 3 = non-Hispanic White, 4 = non-Hispanic Black, and 5 = other race; marital status, 1 = married/living with a partner, 2 = never married, and 3 = widowed/divorced/separated. AUC = area under the curve, CI = confidence interval, MCMI = modified cardiometabolic index, TC = total cholesterol.