The C-reactive protein-triglyceride-glucose index (CTI) as a predictor of mortality and hospital stay in critically ill patients: a retrospective cohort study.
Huijian Wang, Longlong Hu, Yang Chen, Huabin He, Yijun Huang, Ruyi Tao, Shiyuan Li, Renqiang Yang
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Abstract
Background: Population aging has increased the demand for intensive care, with critically ill patients facing high mortality and prolonged hospital stays. New biomarkers are needed to predict outcomes early. The C-reactive protein-triglyceride-glucose index (CTI) integrates insulin resistance and inflammation, but its Link to outcomes in critically ill patients is unknown. This study aims to investigate the association between CTI and 30-day and 365-day all-cause mortality and length of hospital stay in critically ill patients.
Methods: This retrospective study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, including 2,428 ICU patients admitted from 2008 to 2022. The primary outcomes were 30-day and 365-day all-cause mortality, while secondary outcomes included length of hospital stay and ICU stay. CTI was calculated based on biochemical data (CRP, triglycerides, and glucose). Kaplan-Meier survival analysis, Cox regression models, and mediation analysis were employed to assess the relationship between CTI and clinical outcomes.
Results: Higher CTI levels were associated with increased all-cause mortality at both 30 days (HR: 1.81, 95% CI: 1.31-2.52, P < 0.001 for the highest quartile) and 365 days (HR: 1.80, 95% CI: 1.43-2.28, P < 0.001 for the highest quartile). CTI exhibited a Linear relationship with mortality, with each unit increase in CTI corresponding to a 25% increase in 30-day mortality and a 26% increase in 365-day mortality. Nutritional risk, assessed by the Geriatric Nutritional Risk Index (GNRI) levels, significantly mediated the association between CTI and mortality, with a stronger effect observed in long-term outcomes. Furthermore, CTI outperformed the triglyceride-glucose (TyG) index and C-reactive protein (CRP) in predicting mortality, and the results remained consistent after adjusting for baseline severity scores. Additionally, higher CTI levels were associated with longer hospital and ICU stays (β = 0.44 days and β = 0.22 days, respectively, P < 0.001).
Conclusions: CTI is a robust predictor of mortality and hospital stay duration in critically ill patients, integrating the effects of insulin resistance and inflammation. Nutritional risk plays a significant mediating role in the association between CTI and mortality, particularly in long-term outcomes. CTI may serve as a valuable tool for early risk stratification and clinical decision-making in the ICU setting.
期刊介绍：
Lipids in Health and Disease is an open access, peer-reviewed, journal that publishes articles on all aspects of lipids: their biochemistry, pharmacology, toxicology, role in health and disease, and the synthesis of new lipid compounds.
Lipids in Health and Disease is aimed at all scientists, health professionals and physicians interested in the area of lipids. Lipids are defined here in their broadest sense, to include: cholesterol, essential fatty acids, saturated fatty acids, phospholipids, inositol lipids, second messenger lipids, enzymes and synthetic machinery that is involved in the metabolism of various lipids in the cells and tissues, and also various aspects of lipid transport, etc. In addition, the journal also publishes research that investigates and defines the role of lipids in various physiological processes, pathology and disease. In particular, the journal aims to bridge the gap between the bench and the clinic by publishing articles that are particularly relevant to human diseases and the role of lipids in the management of various diseases.
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