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Background <p>The prognostic utility of the triglyceride-glucose (TyG) index and its anthropometry-enhanced variants (TyG-WC, TyG-WHtR, TyG-BMI) for mortality risk in advanced cardiovascular–liver–kidney–metabolic syndrome (CLKM), a multisystem condition involving heart, liver, kidney, and metabolic health, remains unknown.</p> Methods <p>This nationwide prospective cohort study included 1384 adults with advanced CLKM syndrome from NHANES 1999–2018. The associations between the TyG index, its modified variants, and all-cause mortality were assessed using weighted multivariable Cox proportional hazards models. Restricted cubic splines (RCS) were used to identify nonlinear associations. To compare predictive performance, C-index, net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated.</p> Results <p>Over a mean 56-month follow-up, 360 deaths were recorded. RCS revealed U-shaped associations (i.e., lower risk at intermediate levels and higher risk at both low and high levels) between TyG indices and mortality (<i>P</i> for nonlinear&lt; 0.05), with inflection points at TyG = 9.56, TyG-WC = 1,039.11, TyG-WHtR = 5.17, and TyG-BMI = 215.85. At values below the inflection points, higher indices were associated with reduced mortality risk. Comparison based on the C-index, NRI, and IDI showed that the modified TyG indices did not outperform the original TyG in mortality prediction. Subgroup analyses confirmed consistency (<i>P</i> for interaction &gt;0.05).</p> Conclusion <p>In advanced CLKM syndrome, TyG indices exhibit U-shaped mortality association, revealing dual metabolic roles. The original TyG index performs comparably to anthropometry-enhanced variants, supporting its use as a parsimonious risk-stratification tool. Identified inflection points offer actionable thresholds for personalized management.</p>

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Comparison of the triglyceride-glucose index and its modified indices for predicting mortality in advanced CLKM syndrome

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月14日

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  • Jiahua Liang,
  • Huamei Li,
  • Yueqiao Zhong,
  • Ping Li,
  • Zhihua Huang,
  • Dawei Wang,
  • Junmao Wen

摘要

Background

The prognostic utility of the triglyceride-glucose (TyG) index and its anthropometry-enhanced variants (TyG-WC, TyG-WHtR, TyG-BMI) for mortality risk in advanced cardiovascular–liver–kidney–metabolic syndrome (CLKM), a multisystem condition involving heart, liver, kidney, and metabolic health, remains unknown.

Methods

This nationwide prospective cohort study included 1384 adults with advanced CLKM syndrome from NHANES 1999–2018. The associations between the TyG index, its modified variants, and all-cause mortality were assessed using weighted multivariable Cox proportional hazards models. Restricted cubic splines (RCS) were used to identify nonlinear associations. To compare predictive performance, C-index, net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated.

Results

Over a mean 56-month follow-up, 360 deaths were recorded. RCS revealed U-shaped associations (i.e., lower risk at intermediate levels and higher risk at both low and high levels) between TyG indices and mortality (P for nonlinear< 0.05), with inflection points at TyG = 9.56, TyG-WC = 1,039.11, TyG-WHtR = 5.17, and TyG-BMI = 215.85. At values below the inflection points, higher indices were associated with reduced mortality risk. Comparison based on the C-index, NRI, and IDI showed that the modified TyG indices did not outperform the original TyG in mortality prediction. Subgroup analyses confirmed consistency (P for interaction >0.05).

Conclusion

In advanced CLKM syndrome, TyG indices exhibit U-shaped mortality association, revealing dual metabolic roles. The original TyG index performs comparably to anthropometry-enhanced variants, supporting its use as a parsimonious risk-stratification tool. Identified inflection points offer actionable thresholds for personalized management.