C-reactive protein–triglyceride–glucose index and diabetes status for risk stratification in stage 4 cardiovascular–kidney–metabolic syndrome with acute decompensated heart failure: a retrospective cohort study

Figures

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  Figure 1. Flowchart of the study population. CKM stage 4 was operationally defined according to the AHA CKM staging framework as clinical cardiovascular disease, represented in this cohort by hospitalization for ADHF, plus at least one documented CKM-related metabolic, renal, or adiposity-related abnormality. Of 2,988 screened patients, 988 were excluded sequentially: Age <18 years (n = 62), no qualifying CKM-related abnormality (n = 225), missing CTI variables (n = 121), unavailable follow-up (n = 153), acute infection (n = 215), active malignancy (n = 91), or another systemic inflammatory disease (n = 121). ADHF, acute decompensated heart failure; CKM, cardiovascular–kidney–metabolic; CTI, C-reactive protein–triglyceride–glucose index; DM, diabetes mellitus.

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  Figure 2. Conventional Kaplan–Meier curves according to diabetes status and CTI level. Kaplan–Meier curves are shown for all-cause mortality (A) and major adverse cardiac and cerebrovascular events (MACCEs) (B) according to the four groups defined by diabetes status and CTI level: non-DM + low CTI, non-DM + high CTI, DM + low CTI, and DM + high CTI. Numbers at risk are shown below the x-axis. p values were calculated using the log-rank test. CTI, C-reactive protein–triglyceride–glucose index; DM, diabetes mellitus; MACCEs, major adverse cardiac and cerebrovascular events.

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  Figure 3. Restricted cubic spline analyses of the associations between CTI and all-cause mortality and MACCEs in the overall cohort and in the DM and non-DM subgroups. (A–C) Associations between CTI and all-cause mortality in the overall cohort, DM subgroup, and non-DM subgroup, respectively. (D–F) Associations between CTI and MACCEs in the overall cohort, DM subgroup, and non-DM subgroup, respectively. Solid lines indicate hazard ratios, and shaded areas indicate 95% confidence intervals. p values for overall association and non-linearity are shown in each panel.

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  Figure 4. Forest plots for subgroup analyses of the associations of the DM + high CTI group with all-cause mortality and MACCEs. (A) All-cause mortality. (B) Major adverse cardiac and cerebrovascular events (MACCEs). Hazard ratios (HRs) and 95% confidence intervals (CIs) are shown for the association of the DM + high CTI group with study outcomes across clinically relevant subgroups, using the non-DM + low CTI group as the reference group. Nominal interaction p values are shown; FDR-adjusted values for the 24-test family are reported in Supplementary Table S12.