The Prognostic Role of C-Reactive Protein-Triglyceride Glucose Index in Predicting Unfavorable Outcomes in Acute...

The C-reactive protein-triglyceride glucose index (CTI) has been established as a novel biomarker reflecting insulin resistance and systemic inflammation. However, its association with unfavorable outcomes in acute ischemic stroke (AIS), especially when patients are stratified by glycemic status, remains unclear.

A total of 1485 patients with AIS admitted to Seoul National University Hospital between 2010 and 2016 were included in this study. The primary outcome was poor prognosis, defined as a modified Rankin scale score ≥3 at 3 months. The CTI was calculated via the following formula: 0.412 × ln (hs-CRP [mg/L]) + ln (TG [mg/dL] × FBG [mg/dL])/2. Logistic regression models and restricted cubic spline analyses were used to evaluate the associations between the CTI and poor stroke outcomes, with stratification by sex and glycemic status. Subgroup analyses and propensity score analyses were also conducted to validate the robustness of the findings.

At 3 months after AIS onset, 414 patients (27.88%) experienced poor outcomes. Our findings revealed a significant positive linear association between CTI levels and the risk of unfavorable outcomes in AIS patients. The association was significant in both sexes, with a higher odds ratio observed in males (OR 1.591, 95% CI: 1.235-2.050) than in females (OR 1.347, 95% CI: 1.004-1.807). When individuals were stratified by glycemic status, an elevated CTI was significantly associated with an increased risk of poor outcomes among individuals with prediabetes (pre-DM) (OR 1.634, 95% CI: 1.267-2.108) and diabetes mellitus (DM) (OR 1.819, 95% CI: 1.315-2.517), whereas no statistically significant association was observed in participants with normal glucose regulation.

Elevated CTI levels were significantly associated with an increased risk of unfavorable outcomes in AIS patients, with a stronger association observed in males. This relationship remained significant among individuals with prediabetes and diabetes but was not evident in those with normal glucose regulation. These findings suggest that the CTI may serve as a simple and effective biomarker for identifying AIS patients at greater risk of poor prognosis.