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Published on: April 28, 2020

C-reactive protein-triglyceride-glucose index (CTI) as a predictor of chronic liver disease in adults with macrocytic

Wenjing Shang1, Jiachen Li2, Jinhua Zhuo1

  • 1Department of Clinical Laboratory Medicine, Shandong Provincial Third Hospital, Shandong University, Jinan, 250031, China.

Scientific Reports
|May 9, 2026
PubMed

Insights

A new C-reactive protein-triglyceride-glucose index (CTI) may help identify individuals with macrocytic anemia at higher risk for chronic liver disease (CLD). This simple indicator shows promise for early prevention strategies in at-risk populations.

Area of Science:

  • Internal Medicine
  • Hepatology
  • Hematology

Background:

  • Macrocytic anemia often indicates liver dysfunction, but reliable predictive biomarkers for chronic liver disease (CLD) are limited.
  • Identifying individuals with macrocytic anemia who are at risk for CLD is crucial for timely intervention.

Purpose of the Study:

  • To investigate the association between the C-reactive protein-triglyceride-glucose index (CTI) and the risk of developing chronic liver disease (CLD) in individuals with macrocytic anemia.
  • To evaluate the CTI as a potential biomarker for predicting CLD in this specific patient group.

Main Methods:

  • A longitudinal study of 693 individuals with macrocytic anemia (mean corpuscular volume > 100 fL) from the China Health and Retirement Longitudinal Study (CHARLS).
  • Calculation of the C-reactive protein-triglyceride-glucose index (CTI) using a defined formula.
  • Assessment of the association between CTI and CLD risk using sequentially adjusted Cox regression models, restricted cubic splines, and subgroup analyses.
  • Development of a clinical nomogram using LASSO regression for risk prediction.

Main Results:

  • A higher CTI was significantly associated with an increased risk of developing CLD, even after adjusting for demographic, lifestyle, and socioeconomic factors (HR=1.607, P=0.018).
  • Restricted cubic spline analysis revealed a consistent linear positive relationship between CTI and CLD risk.
  • The predictive ability of CTI was validated across diverse subgroups and incorporated into a prediction tool with fair performance.

Conclusions:

  • The C-reactive protein-triglyceride-glucose index (CTI) shows potential as a simple, accessible biomarker for identifying individuals with macrocytic anemia at elevated risk of chronic liver disease (CLD).
  • CTI can aid in early risk stratification, facilitating targeted prevention and management strategies for chronic liver disease in patients with macrocytic anemia.

Keywords:
C-reactive protein-triglyceride glucose indexCHARLSchronic liver diseaselongitudinal researchmacrocytic anemia

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