Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Correlation between hs-CRP-triglyceride glucose index and NAFLD and liver fibrosis,” published in the April 2025 issue of the BMC Gastroenterology by Zhou et al.

The novel serum high-sensitivity C-reactive protein-triglyceride glucose index (CTI) has emerged as a composite biomarker that captures both insulin resistance and systemic inflammation—two interrelated mechanisms believed to play central roles in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis. This study investigates the association between CTI and the prevalence of NAFLD and liver fibrosis among U.S. adults, leveraging nationally representative data to evaluate the index’s clinical relevance.

This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) for the years 2017 through 2020. A total of 3,488 adult participants were included in the final cohort after applying appropriate inclusion and exclusion criteria. The CTI was computed using the following formula: 0.412 × ln(hs-CRP) + ln(triglycerides × fasting plasma glucose / 2), incorporating high-sensitivity C-reactive protein (hs-CRP), triglycerides, and fasting plasma glucose as core components.

To assess the relationship between CTI and the presence of NAFLD and liver fibrosis, multivariable logistic regression models were employed with progressive adjustment for demographic, clinical, and lifestyle-related covariates. Subgroup analyses were conducted to evaluate consistency across stratified variables, including age, sex, BMI, and comorbidities. Additionally, restricted cubic spline regression was used to explore potential non-linear associations, while ROC curve analysis was applied to evaluate the discriminatory capacity of CTI in comparison to its individual components—TyG index and hs-CRP.

Among the participants, 42.7% (n = 1,488) were classified as having NAFLD, while 9.4% (n = 329) exhibited evidence of liver fibrosis. After adjusting for confounders, CTI showed a robust and statistically significant linear association with both NAFLD and liver fibrosis. For each unit increase in CTI, the odds of having NAFLD increased nearly two-fold (OR = 1.94; 95% CI: 1.70–2.22), while the odds of liver fibrosis rose by 38% (OR = 1.38; 95% CI: 1.14–1.67). These associations remained consistent across all subgroup analyses, with no significant interactions observed.

The RCS analysis confirmed the linearity of the association between CTI and both liver outcomes. In comparative performance evaluation, ROC analysis demonstrated that CTI had superior diagnostic capability relative to the TyG index and hs-CRP alone, with an area under the curve (AUC) of 0.756 for NAFLD and 0.702 for liver fibrosis.

This study highlights CTI as a valuable biomarker that simultaneously reflects metabolic and inflammatory states, both of which are integral to the development and progression of NAFLD and liver fibrosis. The strong, independent associations observed between elevated CTI and the prevalence of these liver conditions underscore its potential as a non-invasive tool for early risk identification and clinical monitoring. These findings support the integration of CTI in routine metabolic and hepatic health assessments, particularly in populations at high risk for NAFLD-related complications.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03870-7