The C-reactive Protein-Triglyceride-Glucose Index in Relation to Liver Disease

To investigate the predictive value of the C-reactive protein-triglyceride-glucose index (CTI) for liver disease events in a community-based middle-aged and older population. Based on data from 5 waves of the China Health and Retirement Longitudinal Study (CHARLS) database, this study utilized data from the 2011 and 2015 waves, which included blood samples. A time-dependent Cox regression model was employed to analyze the association between CTI and the risk of liver disease events. Rigorous model testing, along with robustness and heterogeneity analyses, were conducted. A total of 733 incident liver disease events were documented during the follow-up period. After full adjustment for confounding factors, each 1-unit increment in CTI was significantly associated with a 21.0% increased risk of liver disease (Hazard Ratio [HR] = 1.210, 95% Confidence Interval [CI]: 1.109-1.321). In addition, each quartile increase in baseline CTI was associated with a statistically significant 12.2% elevated risk of incident liver disease. This association remained robust in sensitivity analyses after excluding events with potential reverse causality and replacing biomarkers. Subgroup analyses further identified consistent patterns of this association across different populations. This study is the first to demonstrate, within a nationally representative community-based cohort of middle-aged and older adults, that the CTI is an independent and robust predictor of incident liver disease. As a composite metabo-inflammatory marker, the CTI model exhibited slightly better model fit (lower AIC/BIC) and marginally higher discriminatory ability (C-index) than the single-marker models of TyG index and CRP alone. It can be utilized to identify high-risk individuals in middle-aged and older populations, providing a novel epidemiological tool for the early warning of liver disease.