Triglyceride-Glucose-Waist-to-Height Ratio links to aging and mortality in cardiovascular-kidney-metabolic syndrome

Chronic kidney disease (CKD) is a global health concern associated with an elevated risk of cardiovascular (CV) and all-cause mortality. The ankle-brachial index (ABI), a noninvasive diagnostic tool, is widely recognized for detecting peripheral arterial disease. This meta-analysis aims to assess whether abnormally low or high ABI values independently predict CV and all-cause mortality in CKD patients, including those on hemodialysis. A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Cochrane, and Google Scholar databases through September 2024 to identify studies on abnormal ABI and mortality outcomes in CKD patients with or without hemodialysis. Data was analyzed with random-effects models, and subgroup analyses evaluated variations by patient characteristics, region, sample size, and follow-up duration. The analysis included 10 cohort studies comprising 13,378 participants. ABI values between 0.9 and 1.3 were defined as normal. Individuals with abnormally low ABI (<0.9) demonstrated a significantly higher incidence in CV mortality [hazard ratio (HR) = 2.23; confidence interval (CI), 1.75-2.83) and all-cause mortality (HR = 1.78; CI, 1.55-2.05). Those with high ABI ≥1.3 were associated with a 2.77-fold increase in CV mortality (HR = 2.77; CI, 1.74-4.41) and a 1.49 higher risk of all-cause mortality (HR = 1.49; CI, 1.09-2.02). Overall, abnormal ABI values were linked to a 1.74 higher risk of all-cause mortality (HR = 1.74; CI, 1.54-1.96) and a 2.34-fold increase in CV mortality (HR = 2.34; CI, 1.93-2.85). Subgroup analyses revealed higher mortality risks in hemodialysis patients compared with nondialysis CKD patients and in studies conducted in Asia. Abnormal ABI values show a U-shaped relationship with mortality, serving as strong predictors of CV and all-cause mortality in CKD patients, particularly those on hemodialysis. Since CV and all-cause mortality are high in CKD patients, these findings suggest that ABI measurement is a useful screening technique to assist in prognosticating such patients. Further studies are warranted to validate these findings and to better understand the prognostic utility of ABI across different CKD stages, including both dialysis-dependent and nondialysis CKD patients.

Background: The relationship between magnesium and mortality in hemodialysis patients has been evaluated in several prospective studies, but few have assessed the risk of all-cause mortality in elderly hemodialysis patients. The aim of this study was to evaluate the association between magnesium levels and the risk of cardiovascular and overall mortality in elderly maintenance hemodialysis patients. Methods: This was a retrospective study, and patients undergoing maintenance hemodialysis were screened for eligibility at a single dialysis center between July and December 2016. Patients were divided into two groups based on their magnesium levels: a low magnesium level group and a high magnesium level group. Associations between magnesium level and risk of cardiovascular and all-cause mortality were analyzed with a Cox proportional hazards regression model. Results: In total, 413 patients were included with a median follow-up period of 12 months. We found that compared to patients with high magnesium levels, those with low magnesium levels had significantly lower levels of hemoglobin, urea, creatinine, uric acid, phosphate, potassium, chloride, albumin, and spKt/V (p < 0.05 for each parameter). There was a strong correlation between the baseline mean serum magnesium concentration 1 year prior and the concentration 1 year later (r² = 0.519, p < 0.001). After adjustment for confounding factors, multivariate Cox proportional hazards analysis showed hypomagnesemia to be an independent predictor of all-cause and cardiovascular mortality in chronic hemodialysis patients. Furthermore, subgroup analysis was performed, revealing that serum magnesium levels were still strongly associated with all-cause mortality and cardiovascular mortality in patients older than 60 years, with HR values of 0.020 (95% CI 0.001–0.415) and 0.010 (95% CI 0.000–0.491), respectively. In addition, there were still significant associations between the serum magnesium level and all-cause mortality and cardiovascular mortality in elderly dialysis patients at the 6-month follow-up visit. Conclusion: Our study indicates that lower serum magnesium levels are strongly associated with cardiovascular and all-cause mortality in maintenance hemodialysis patients, especially in the short term and in those who are elderly. Factors affecting serum magnesium concentrations in hemodialysis patients should be investigated, and correcting hypomagnesemia may benefit elderly hemodialysis patients.

Hypertension in Hemodialysis Patients: The Role of Antihypertensive Medications

Non-high-density lipoprotein cholesterol and mortality among peritoneal dialysis patients

The relationship between the Blood Urea Nitrogen to Albumin Ratio (BAR) and cardiovascular diseases in diabetes, as well as cardiovascular and all-cause mortality, is not yet entirely understood. This study aimed to examine the correlation between the serum urea nitrogen to albumin ratio and cardiovascular diseases, cardiovascular mortality, and all-cause mortality in diabetes. A total of 7043 adult diabetes patients were included from the NHANES database from 2001 to 2018. The relationship between BAR and cardiovascular diseases, cardiovascular mortality and all-cause mortality in patients with diabetes mellitus was verified using baseline characteristic analysis, multivariate logistic regression analysis, multivariate Cox proportional hazards model, Kaplan-Meier (K-M) analysis, smoothed fitted curves, and subgroup analysis. Results of the logistic regression analysis indicated a substantial positive association, between the BAR and the risk of cardiovascular disease in individuals with diabetes (HR, 1.09 [95% CI 1.06-1.12], p < 0.001). Cox regression analysis revealed a substantial positive association between the BAR and the risk of cardiovascular (OR, 1.13 [95% CI, 1.10-1.17], p < 0.001) and all-cause mortality (OR, 1.12 [95% CI 1.11-1.14], p < 0.001) in diabetes. The restricted cubic spline (RCS) curves indicated a non-linear relationship between BAR and the risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes (p < 0.01). The receiver operating characteristic (ROC) curves demonstrated that the BAR had superior predictive performance for cardiovascular risk (AUC: 0.648), cardiovascular mortality (AUC: 0.618), and all-cause mortality (AUC: 0.674) compared to the body mass index (BMI) (cardiovascular risk AUC: 0.525, cardiovascular mortality AUC: 0.563, all-cause mortality AUC: 0.571) and the weight-adjusted-waist index (WWI) (cardiovascular risk AUC: 0.579, cardiovascular mortality AUC: 0.497, all-cause mortality AUC: 0.570). These results underscore the enhanced ability of the BAR to discriminate between positive and negative outcomes, making it a more effective predictor than WWI. Kaplan-Meier analysis further verified the predictive capacity of BAR, for cardiovascular mortality and all-cause mortality in diabetes patients. Subgroup analysis revealed consistent associations between BAR and a variety of subgroups. The incidence of cardiovascular disease, cardiovascular mortality, and all-cause mortality was substantially elevated, in patients with diabetes with a higher BAR level. Cardiovascular disease, cardiovascular mortality, and all-cause mortality may be more prevalent among diabetic patients with elevated BAR levels. BAR is a novel marker for the prediction of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes.

Both triglyceride-glucose (TyG) index, as a surrogate marker of insulin resistance, and low-density lipoprotein cholesterol (LDL-C) are independent risk factors for long-term prognosis among patients with cardio-renal-metabolic (CRM) disease. However, the co-exposures of TyG index and LDL-C to mortality is unclear. The aim of this study is to investigate the joint effects and risk stratification of the TyG index and LDL-C on all-cause and cardiovascular mortality in CRM patients. We analyzed CRM patients from the National Health and Nutrition Examination Survey (NHANES) database (1999–2018), calculating TyG index as Ln[fasting triglyceride (mg/dL)×fasting glucose (mg/dL)/2] and using multivariable Cox regression models to assess the joint effects of TyG index and LDL-C on all-cause and cardiovascular mortality. The interaction between the TyG index and LDL-C to mortality was also evaluated. During a median follow-up of 7.6 years, 22.8% and 8.4% of patients died from all-cause and cardiovascular causes, respectively. Among patients with LDL-C < 2.6 mmol/L, no significant differences were observed in all-cause and cardiovascular mortality when comparing higher TyG index to the lowest tertile (T1). Specifically, the hazard ratio (HR) for all-cause mortality in the second (T2) and third tertiles (T3) were 0.81 (95% confidence interval(CI): 0.59–1.09) and 0.87 (95%CI: 0.62–1.22), respectively, with a P for trend of 0.468. For cardiovascular mortality, the HR for T2 and T3 compared to T1 were 0.80 (95%CI: 0.48–1.32) and 0.72 (95%CI: 0.45–1.15), respectively, with a P for trend of 0.173. However, elevated TyG index was related to markedly increased risk of all-cause and cardiovascular mortality in patients with LDL-C ≥ 2.6 mmol/L. Specifically, for all-cause mortality, HR for T2 and T3 compared to T1 were 1.01 (95%CI: 0.79–1.28) and 1.38 (95%CI: 1.07–1.79), respectively, with a P for trend of 0.009. For cardiovascular mortality, the HR was 1.09 (95% CI: 0.72–1.65) for T2 and 1.80 (95% CI: 1.18–2.75) for T3, with a P for trend of 0.005. Interactive analysis also demonstrated that a significant association of TyG index and LDL-C with the risk of all-cause (P for interaction = 0.011) and cardiovascular (P for interaction = 0.050) mortality was observed. The findings highlight that elevated TyG index can significantly increase the risk of all-cause and cardiovascular mortality only among CRM patients with LDL-C ≥ 2.6 mmol/L, but not among patients with LDL-C < 2.6 mmol/L.

ObjectiveThis study aimed to investigate the linear association between lipoprotein(a) [Lp(a)] levels and all-cause and cardiovascular mortality in patients with acute coronary syndrome (ACS).MethodsThis retrospective cohort study included 578 patients with ACS who were hospitalized at Henan Provincial People’s Hospital between January 2020 and January 2024. Patients were categorized into two groups: lower Lp(a) group (≤ 300 mg/L) and higher Lp(a) group (> 300 mg/L). Kaplan-Meier survival analysis, Cox regression models, subgroup and sensitivity analyses were used to evaluate the association between Lp(a) and all-cause and cardiovascular mortality. Restricted cubic spline (RCS) analysis was conducted to explore nonlinear associations.ResultsDuring a median follow-up of 27.5 months, a total of 124 all-cause deaths occurred (21.5%), of which 79 cases (13.7%) were classified as cardiovascular deaths. Compared to the lower Lp(a) group, the higher Lp(a) group exhibited a significantly increased risk of all-cause and cardiovascular mortality across all models. In the fully adjusted model (Model 3), the hazard ratio (HR) for all-cause mortality was 1.719 (95% confidence interval [CI]: 1.197–2.470, P = 0.003), while the HR for cardiovascular mortality was 2.505 (95% CI: 1.529-4.102, P < 0.001). In an additional analysis using a 500 mg/L cut-off, patients with Lp(a) > 500 mg/L had a significantly higher risk of cardiovascular mortality (HR = 2.209, P = 0.001), while the association with all-cause mortality (P = 0.284) was not statistically significant in the fully adjusted model. When Lp(a) was analyzed as a continuous variable, each 90 mg/L increase in Lp(a) was associated with a 5% higher risk of all-cause mortality (HR = 1.052, 95% CI: 1.003-1.104, P = 0.038), and each 45 mg/L increase was associated with a 5% higher risk of cardiovascular mortality (HR = 1.054, 95% CI: 1.026-1.084, P < 0.001). For log10-transformed Lp(a), the HR was 1.954 (95% CI: 1.252-3.050, P = 0.003) for all-cause mortality and 3.913 (95% CI: 2.108-7.265, P < 0.001) for cardiovascular mortality. Similarly, for standardized Lp(a) (Z-score), the HR was 1.178 (95% CI: 1.009-1.375, P = 0.038) for all-cause mortality and 1.408 (95% CI: 1.179-1.681, P < 0.001) for cardiovascular mortality. Most subgroup analyses showed that elevated Lp(a) levels were significantly associated with an increased risk of all-cause and cardiovascular mortality (P < 0.05). Sensitivity analyses confirmed the robustness of the findings, with significant associations persisting after excluding patients with early mortality or without stent implantation. Kaplan-Meier analysis showed that both all-cause and cardiovascular survival rates were significantly lower in the high Lp(a) group compared to the low Lp(a) group (P < 0.001 for both). RCS analyses revealed a linear positive association between Lp(a) levels and both all-cause and cardiovascular mortality.ConclusionsHigher Lp(a) levels were independently and linearly associated with an increased risk of all-cause and cardiovascular mortality in ACS patients.

Advanced cardiovascular-kidney-metabolic (CKM) syndrome refers to stages 3 and 4 of CKM syndrome, which are associated with higher mortality compared to earlier stages (0-2). The albumin (ALB)-to-neutrophil/lymphocyte ratio (ANLR) is a new predictive marker that participates in immune inflammation and dietary status. However, the influence of ANLR on all-cause mortality (ACM) and cardiovascular mortality (CVM) in individuals with advanced CKM syndrome remains unclear. This investigation aims to examine the link between ANLR and both ACM and CVM in this population using data from a large-scale cross-sectional survey in the United States. Data were from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, a nationally representative cross-sectional survey with longitudinal mortality follow-up from the National Death Index. The formula of ANLR is ALB/NLR. The diagnostic criteria of CKM syndrome was based on the concept proposed by the American Heart Association and modified criteria adapted for NHANES data availability. The outcomes of interested included ACM and CVM. A 1:1 propensity score matching (PSM) approach was used to control for potential confounding variables. The threshold value of ANLR influencing survival was determined using maximally selected rank statistics, which is based on the log-rank test. This method identifies the optimal cutoff for continuous variables where the difference in survival rates is most pronounced, making it particularly well-suited for analyzing time-to-event data, such as survival outcomes. Kaplan-Meier survival analysis and multivariate Cox proportional hazards models were employed to assess the effects of ANLR on both ACM and CVM. Restricted cubic spline (RCS) analysis evaluated the linear or non-linear association between ANLR and mortality outcomes. Stratified analysis and interaction testing were carried out to estimate the influence of covariates on the ANLR-mortality correlation. A total of 3,266 adults with advanced CKM syndrome (41.12% male) were included in the analysis, with median (interquartile range) age of 73 (63-80). Prior to PSM, and fully adjustment, the lowest ANLR Tertile 1 was related to significantly higher risks of ACM (hazard ratio [HR]: 1.58, 95% confidence interval [CI]: 1.39-1.78, p < 0.001) and CVM (HR: 1.65, 95% CI: 1.34-2.04, p < 0.001) compared to the highest Tertile 3. After applying PSM, and fully adjusting for confounders, an ANLR score below 1.04 was independently linked to increased risks of both CVM (HR: 2.02, 95% CI: 1.49-2.75, p < 0.001) and ACM (HR: 1.52, 95% CI: 1.27-1.81, p < 0.001). Interaction tests revealed no significant interactions for CVM across subgroups (All P interaction > 0.05). Regarding ACM, interactions were noted between ANLR and age, gender, and CKM stages (All P interaction < 0.05). RCS analysis indicated an L-shaped link between ANLR and both ACM and CVM, both before and after PSM (all P non-linearity < 0.001). The predictive value of ANLR, NLR, and ALB for CVM and ACM in individuals with advanced CKM syndrome demonstrated that ANLR and NLR exhibited comparable predictive capabilities for both ACM and CVM, outperforming ALB. Furthermore, the predictive performance of ANLR and NLR for ACM was superior to that for CVM. Lower ANLR values, indicative of elevated systemic inflammation and malnutrition, are independently linked to increased risks of both ACM and CVM in individuals with advanced CKM syndrome in the US. These readily accessible and low-cost blood markers could serve as valuable prognostic indicators for identifying high-risk individuals. Future research should focus on incorporating additional biomarkers, validating the indices in larger and more diverse cohorts, and employing advanced analytical methods to refine the diagnostic efficiency of ANLR and NLR for better clinical utility.

Rheumatoid arthritis (RA) is associated with systemic inflammation and an elevated risk of all-cause and cardiovascular mortality. The neutrophil percentage-to-albumin ratio (NPAR) is a novel composite biomarker integrating inflammatory and nutritional status, but its prognostic role in RA remains unknown. This study included 685 U.S. adults with RA from the National Health and Nutrition Examination Survey (NHANES) 1999-2010. NPAR was calculated as neutrophil percentage divided by serum albumin and categorized into tertiles (Q1: low, Q2: medium, Q3: high). All-cause and cardiovascular mortality were obtained via linkage to the National Death Index. Multivariable Cox proportional hazards models were used to assess the association between NPAR and mortality, with sequential adjustment for demographic, lifestyle, and clinical factors. In addition to NPAR, we also examined the individual components (neutrophil percentage, serum albumin) and C-reactive protein (CRP) for comparative analysis. Kaplan-Meier survival curves and restricted cubic splines (RCS) were used to visualize survival differences and dose-response relationships. Over a median follow-up of 155.66months, compared with Q1, the highest NPAR tertile (Q3) was independently associated with increased risks of all-cause mortality (fully adjusted hazard ratio [HR] = 1.87, 95% confidence interval [CI] 1.18-2.96,P = 0.008). Continuous NPAR was independently associated with increased risks of all-cause mortality (fully adjusted hazard ratio [HR] = 1.16, 95% confidence interval [CI] 1.08-1.24,P < 0.001) and cardiovascular mortality (HR = 1.23, 95% CI 1.06-1.42,P = 0.005). In comparative analyses, serum albumin also showed a strong inverse association with all-cause mortality (all-cause: HR = 0.26, 95% CI 0.15-0.47, P < 0.001), while neutrophil percentage and CRP demonstrated weaker or non-significant associations after full adjustment. Kaplan-Meier curves showed progressively lower survival across NPAR tertiles (log-rankP < 0.001). RCS analysis indicated a linear dose-response relationship between continuous NPAR and both mortality outcomes (all-cause: overallP < 0.001, nonlinearP = 0.090; cardiovascular: overallP = 0.002, nonlinearP = 0.290). Elevated NPAR is an independent predictor of all-cause and cardiovascular mortality in patients with RA. Given its accessibility and low cost, NPAR may serve as a practical biomarker for risk stratification and prognostic assessment in RA management. Key Points • This study identifies the neutrophil percentage-to-albumin ratio (NPAR) as a novel, independent predictor of both all-cause and cardiovascular mortality in patients with rheumatoid arthritis. • The association between higher NPAR and increased mortality risk persists after rigorous adjustment for traditional risk factors, health behaviors, and clinical comorbidities, as well as mutual adjustment for C-reactive protein (CRP). • NPAR, calculated from routine complete blood count and metabolic panels, is a more comprehensive prognostic tool than its individual components (neutrophil percentage or albumin alone). • The findings suggest NPAR could be a practical and cost-effective biomarker for improving risk stratification and guiding more aggressive management in high-risk RA patients.

The optimal blood pressure (BP) targets for patients with type 2 diabetes (T2D) remain debated among international guidelines. This retrospective cohort analysis evaluated the associations of specific systolic and diastolic BP (SBP and DBP) categories with long-term mortality in patients with T2D. We analyzed 2,198 adults with T2D from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Participants were stratified by baseline SBP (<130, 130-140, ≥140 mmHg) and DBP (<80, 80-89, ≥90 mmHg). Multivariable Cox proportional hazards models were constructed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cardiovascular, cerebrovascular, and diabetes-related mortality, adjusting for comprehensive baseline covariates. Over a median follow-up of 97.0 months, an SBP ≥140 mmHg was significantly associated with elevated risks for all-cause (HR = 1.66, 95% CI: 1.28-2.16), cardiovascular (HR = 1.53, 95% CI: 1.10-2.13), cerebrovascular (HR = 3.98, 95% CI: 1.71-9.27), and diabetes-related mortality (HR = 1.84, 95% CI: 1.06-3.16) compared to an SBP <130 mmHg. Conversely, a DBP of 80-89 mmHg was associated with significantly lower all-cause (HR = 0.67, 95% CI: 0.46-0.98) and cardiovascular mortality (HR = 0.57, 95% CI: 0.35-0.93) than a DBP <80 mmHg, indicating a distinct J-curve phenomenon. In this observational study, baseline SBP <140 mmHg and DBP 80-89 mmHg were associated with favorable survival outcomes in patients with T2D. These findings suggest that individualized blood pressure management warrants further investigation, taking into account the limitations of observational data and single baseline measurements.

Background:The hemoglobin glycation index (HGI) presents a discrepancy between observed and predicted glycosylated hemoglobin (HbA1c) and fasting blood glucose values. Meanwhile, compared to the HbA1c values, the HGI provides a more comprehensive reflection of blood glucose variability across populations. However, no studies have examined the association between the HGI and all-cause, cardiac, and cardiovascular mortalities in the general population. Hence, this study aimed to investigate these relationships using data from the National Health and Nutrition Examination Survey (NHANES) database.Methods:Participants were stratified into four groups based on the HGI quartiles. Weighted multivariable Cox proportional hazards models were used to assess the associations between HGI and all-cause, cardiovascular, and cardiac mortality. Kaplan–Meier survival analysis based on the HGI quartiles and log-rank tests were employed to compare differences in primary and secondary endpoints. Additionally, restricted cubic spline (RCS) curves were used to explore nonlinear relationships between the HGI and endpoints, identifying inflection points. Subgroup analyses and interaction tests were conducted to assess the robustness of the findings.Results:In comparing the baseline characteristics of endpoints across all-cause mortality, cardiac mortality, and cardiovascular mortality, significantly higher mortality rates were observed in the high HGI quartile group (Q4) compared to the other three groups (Q1, Q2, and Q3) (p < 0.05). Kaplan–Meier curves demonstrated increased mortality risks in the high HGI group across all endpoints (p < 0.05). Multivariable Cox proportional hazards models indicated that high HGI levels were associated with all-cause mortality (Q4: hazard ratio (HR) (95% confidence interval (CI)) = 1.232 (1.065, 1.426); p = 0.005), cardiac mortality (HR (95% CI) = 1.516 (1.100, 2.088); p = 0.011) and cardiovascular mortality (HR (95% CI) = 1.334 (1.013, 1.756); p = 0.039). Low HGI was associated only with all-cause mortality (Q1: HR (95% CI) = 1.269 (1.082, 1.488); p = 0.003). RCS analysis confirmed a U-shaped relationship between the HGI and all three outcome events. Subgroup analyses and interaction tests supported the robustness of the conclusions.Conclusion:This study demonstrates a U-shaped association between the HGI and overall mortality, cardiac mortality, and cardiometabolic mortality in the general population. Specifically, the high HGI value represented a risk factor for all-cause, cardiac, and cardiovascular mortality. In contrast, low HGI values were associated only with all-cause mortality in the general population.

ObjectivesThe emerging triglyceride–glucose (TyG) related index has attracted attention as a promising predictor of various cardiometabolic conditions. However, their prospective association with different stages of cardiovascular-renal metabolic (CKM) syndrome is still not fully established, and it remains unclear whether TyG related parameters have prognostic effects on mortality outcomes of CKM syndrome.MethodsThe data were derived from the China Health and Retirement Longitudinal Study (CHARLS), and which were determined by the use of a standardised questionnaire during follow-up. TyG and its related parameters (TyG-body mass index, TyG-waist circumference, TyG-waist to height ratio, and TyG-a body shape index (TyG-ABSI) were calculated. Multivariate Cox regression analysis was used to analyze hazard ratios (HRs) and 95% confidence intervals (CI), and Kaplan–Meier survival curve was used to analyze the associations of TyG-ABSI with all-cause mortality and cardiovascular mortality in patients with CKM syndrome. Additionally, the multivariate adjusted restricted cubic spine was employed to examine the dose-response relationship. Mediation analysis was conducted to assess whether white blood cell (WBC) and C-reactive protein (CRP) mediated the associations. Subgroup analyses and interaction tests were conducted to evaluate the risk within various demographics. The National Health and Nutrition Examination Survey (NHANES) was used as validation to improve the reliability of the study results.ResultsThe study enrolled 11,235 participants with CKM syndrome from the CHARLS database, during the median follow-up of 5 years, a total of 747 (6.65%) all-cause mortality and 84 (0.75) cardiovascular mortality occurred. TyG-ABSI was associated with CKM syndrome (OR 1.55; 95% CI 1.35–1.79). Furthermore, among patients with CKM syndrome, TyG-ABSI was association with all-cause mortality (HR 1.14; 95% CI 1.04–1.35). In which continuous TyG-ABSI were converted to classified variable (tertile), compared to those with T1 group, the risk of advanced CKM syndrome was found to be 2.41-fold higher in those with T3 group (OR 2.41; 95% CI 1.18–3.20). Additionally, individuals in the T3 group had a 55% increased risk of all-cause mortality (HR 1.55; 95% CI 1.10–2.18). The mediation analysis results suggested that the relationship between TyG-ABSI and all-cause mortality risk is partially mediated by WBC, and CRP, the proportion of mediation were 15.16% and 11.83%. Additionally, analyses of 15,054 participants from the NHANES database indicated a significant positive association between TyG-ABSI and all-cause mortality and cardiovascular mortality among individuals diagnosed with CKM syndrome during the 10 years follow-up.ConclusionHigher TyG-ABSI is associated with an increased risk of advanced CKM syndrome and mortality. It further emphasizes the role of TyG-ABSI in the management of CKM syndrome stages and the risk of all-cause mortality and cardiovascular mortality.Graphical abstractSupplementary InformationThe online version contains supplementary material available at 10.1186/s12933-025-03057-0.

Lipid accumulation product (LAP) is associated with increased risk of metabolic diseases and cardiovascular disease. However, its relationship with all-cause mortality and cardiovascular mortality among diabetes mellitus (DM) patients remains unclear. This study aims to explore the associations between LAP and mortality outcomes in patients with DM. This study included 10,944 patients with DM from the national health and nutrition examination survey. LAP was calculated using waist circumference and triglyceride levels, according to gender-specific formula. All-cause and cardiovascular mortality were determined through linkage with the national death index database through December 31, 2019. Multivariable Cox proportional hazard models examined the associations between LAP and mortality. Restricted cubic splines were used to investigate potential non-linear relationships. A series of subgroup and sensitivity analyses were also performed to evaluate robustness of our results. During a median follow-up of 86 months, 1,508 all-cause deaths and 413 cardiovascular deaths were recorded. Higher LAP levels were associated with an increased risk of both all-cause mortality (highest vs. lowest quartile: hazard ratio [HR] 1.69, 95% CI 1.39–2.05) and cardiovascular mortality (HR 2.02, 95% CI 1.36–3.00). Non-linear relationships were observed between LAP and both all-cause and cardiovascular mortality. Notably, interactions between LAP and both age and diabetes duration were found in relation to all-cause and cardiovascular mortality. The results remained consistent after a series of subgroup and sensitivity analyses. The results didn’t significantly change according to a series of subgroup and sensitivity analyses. Higher LAP levels were associated with increased risks of all-cause and cardiovascular mortality in patients with DM. These findings suggest that LAP could serve as a valuable predictor for mortality risk assessment in diabetic patients.

Introduction: Patients undergoing peritoneal dialysis (PD) experience exceptionally high mortality. While the cardiothoracic ratio (CTR), a simple radiographic measure, has prognostic value in hemodialysis, its role in PD is unclear because of limited evidence. We hypothesized that a high baseline CTR is independently associated with mortality in patients undergoing PD. Methods: We conducted a multicenter cohort study using data from the Fukuoka Peritoneal Dialysis Registry study. Of 1,217 patients who participated in the study between 2011 and 2020, 972 with a baseline CTR were included. The CTR was categorized into sex-specific quartiles. The primary and secondary outcomes were all-cause and cardiovascular mortality, respectively. We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Results: During a median follow-up of 731 days, 156 (16.0%) patients died, including 54 (5.6%) from cardiovascular causes. After multivariable adjustment, patients in the highest CTR quartile had significantly elevated risks of all-cause mortality (HR, 3.01; 95% CI: 1.85–5.04) and cardiovascular mortality (HR, 5.44; 95% CI: 2.17–13.59) compared with the lowest quartile. Each 1-standard deviation increase in the CTR was also associated with a higher risk of all-cause (HR, 1.40; 95% CI: 1.20–1.65) and cardiovascular mortality (HR, 1.68; 95% CI: 1.27–2.23). The findings were consistent in sensitivity analyses. Conclusion: An elevated baseline CTR is an independent predictor of all-cause and cardiovascular mortality in patients undergoing PD. This simple, readily available measure may be a useful tool for risk stratification in this high-risk population.

Background: Studies have shown inconsistent associations between serum uric acid (SUA) levels and mortality in peritoneal dialysis (PD) patients. We conducted this meta-analysis to determine whether SUA levels were associated with cardiovascular or all-cause mortality in PD patients.Methods: PubMed, Embase, Web of Science, the Cochrane Library, CNKI, VIP, Wanfang Database, and trial registry databases were systematically searched up to April 11, 2021. Cohort studies of SUA levels and cardiovascular or all-cause mortality in PD patients were obtained. Random effect models were used to calculate the pooled adjusted hazard ratio (HR) and corresponding 95% confidence interval (CI). Sensitivity analyses were conducted to assess the robustness of the pooled results. Subgroup analyses and meta-regression analyses were performed to explore the sources of heterogeneity. Funnel plots, Begg's tests, and Egger's tests were conducted to evaluate potential publication bias. The GRADE approach was used to rate the certainty of evidence. This study was registered with PROSPERO, CRD42021268739.Results: Seven studies covering 18,113 PD patients were included. Compared with the middle SUA levels, high SUA levels increased the risk of all-cause mortality (HR = 1.74, 95%CI: 1.26–2.40, I2 = 34.8%, τ2 = 0.03), low SUA levels were not statistically significant with the risk of all-cause or cardiovascular mortality (HR = 1.04, 95%CI: 0.84–1.29, I2 = 43.8%, τ2 = 0.03; HR = 0.89, 95%CI: 0.65–1.23, I2 = 36.3%, τ2 = 0.04; respectively). Compared with the low SUA levels, high SUA levels were not statistically associated with an increased risk of all-cause or cardiovascular mortality (HR = 1.19, 95%CI: 0.59–2.40, I2 = 88.2%, τ2 = 0.44; HR = 1.22, 95%CI: 0.39–3.85, I2 = 89.3%, τ2 = 0.92; respectively).Conclusion: Compared with middle SUA levels, high SUA levels are associated with an increased risk of all-cause mortality in PD patients. SUA levels may not be associated with cardiovascular mortality. More high-level studies, especially randomized controlled trials, are needed to determine the association between SUA levels and cardiovascular or all-cause mortality in PD patients.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268739, identifier: CRD42021268739.