Association of triglyceride-glucose (TyG)-Derived inflammatory indices with the risk of all-cause and cardiovascular mortality in patients with chronic kidney disease: A retrospective cohort study based on NHANES 1999–2018

Abstract

Objective The triglyceride-glucose (TyG) index has been explored as a prognostic marker in chronic kidney disease (CKD), but it does not capture the complex interplay of metabolic dysfunction and chronic inflammation inherent to CKD pathogenesis. This study aimed to explore the associations between TyG-derived inflammatory indices and the risks of all-cause and cardiovascular disease (CVD) mortality in patients with CKD. Methods This retrospective cohort study included adults with CKD from the National Health and Nutrition Examination Survey (NHANES) 1999–2018, with mortality follow-up through December 2019. The associations of the TyG index and five TyG-derived inflammatory indices (TyG-NLR, TyG-MLR, TyG-lgPLR, TyG-lgSII, and TyG-SIRI) with mortality risk were evaluated using receiver operating characteristic (ROC) curves and survey-weighted Cox proportional hazards regression models. Results A total of 3,534 patients with CKD were included. TyG-MLR showed the highest area under the ROC curve (AUC) among the evaluated indices, with an AUC of 0.66 for all-cause mortality and 0.68 for CVD mortality. After stratification by TyG-MLR quartiles (Q1–Q4), patients in the Q4 group had an estimated 3.3-year reduction in life expectancy at the age of 45 compared with the Q1 group. Conclusions This study suggests that TyG-derived inflammatory indices may hold clinical value in predicting mortality risk among patients with CKD. In the first systematic comparison of multiple such indices, TyG-MLR emerged as the best-performing indicator, although its discriminative performance was moderate. Prospective validation in independent cohorts is warranted.