The association between C-reactive protein-triglyceride glucose index and all-cause mortality in patients with cardiovascular-kidney-metabolic syndrome: a single-center retrospective cohort study

Abstract

Background Patients with cardiovascular-kidney-metabolic (CKM) syndrome have high mortality risk. The C-reactive protein–triglyceride glucose index (CTI) integrates inflammation and insulin resistance, yet its stage-specific prognostic value is undefined. Methods and results This retrospective cohort study included 8,632 CKM patients (2020–2025), stratified by CTI quartiles. All-cause mortality was assessed using adjusted Cox models. Among 860 deaths (10.0%), CTI was an independent mortality predictor in both stage 0–3 (HR 1.68, 95% CI 1.30–2.18) and stage 4 CKM (HR 1.54, 1.33–1.77). Compared with Q1, Q4 patients had significantly higher risk (stage 0–3: HR 4.57, 2.32–8.99; stage 4: HR 2.26, 1.64–3.13). A linear dose-response relationship was confirmed (P for nonlinear >0.05). CTI showed superior 1-year predictive performance over TyG index (AUC: stage 0–3, 0.73 vs. 0.62; stage 4, 0.69 vs. 0.51). Conclusion CTI is a potent, independent predictor of all-cause mortality in CKM, with a linear dose-response relationship. By integrating inflammatory and metabolic pathways, it provides superior risk stratification over TyG index, highlighting its clinical utility.