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March 15, 2026Frontiers in Endocrinology0 citationsOpen Access

Association between C-reactive protein to triglyceride-glucose index and atrial fibrillation: a cross-sectional analysis

JLJiayi LiuSPShuhan PanBSBingxue Song

Key Result

A higher CTI is significantly and independently associated with an increased prevalence of atrial fibrillation, with an odds ratio of 7.27.

Key Points

  • This study investigates the relationship between the C-reactive protein to triglyceride-glucose index and atrial fibrillation prevalence.
  • Conducted a cross-sectional analysis with 2,988 participants
  • Collected clinical and laboratory data to calculate the CTI
  • Employed multivariable logistic regression for analysis
  • Used restricted cubic spline analysis for dose-response relationship evaluation
  • Assessed CTI's predictive capability using C-index, NRI, and IDI
  • CTI levels were significantly higher in atrial fibrillation participants compared to non-AF participants
  • CTI was positively associated with AF prevalence (OR 7.27, P < 0.001)
  • Significant linear dose-response relationship between CTI and AF risk was identified
  • Adding CTI improved the C-index from 0.6828 to 0.7985 and enhanced NRI and IDI, all P < 0.001

Study Design

Type

Cross-Sectional (n=2,988)

Multicenter

No

Structured PICO

Does an elevated C-reactive protein to triglyceride-glucose index (CTI) correlate with an increased prevalence of atrial fibrillation in a general adult population?

P
Population
2,988 adult participants (aged ≥18 years) from a single center in China, mean age 70.85, 45.76% male. Key inclusion: availability of complete baseline anthropometric and laboratory data. Key exclusions: acute infectious or inflammatory diseases, malignant tumors, severe hepatic or renal dysfunction, or pregnancy.
I
Intervention
Higher C-reactive protein to triglyceride-glucose index (CTI) levels (evaluated as a continuous variable and by tertiles)
C
Comparator
Lower CTI levels (lowest tertile T1 used as the reference group)
O
Outcome
Prevalence of atrial fibrillation (AF) identified via ICD-10 code I48 or electrocardiogram findings

The novel C-reactive protein to triglyceride-glucose index (CTI) is strongly and independently associated with atrial fibrillation prevalence, offering superior risk discrimination compared to traditional clinical models.

Main Result

Effect estimate: OR 7.27 (95% CI 5.87–9.00)

p-value: p=<0.001

Limitations

  • Causal relationships cannot be established due to the observational design.
  • Only a single measurement of CTI was taken, which may not reflect long-term trends.
  • The study population is derived from a single center in China, limiting generalizability.
  • Cross-sectional design cannot establish a causal link
  • Relied on a single blood sample measurement, failing to capture dynamic fluctuations
  • Single source with relatively homogeneous characteristics
  • Predominantly obese population (mean BMI >30 kg/m²), limiting generalizability to leaner populations

Abstract

Objective This study aimed to investigate the association between a novel composite biomarker, the C-reactive protein to triglyceride-glucose index (CTI) and the prevalence of atrial fibrillation (AF) in a general adult population. Methods This cross-sectional study included 2, 988 participants Clinical and laboratory data were collected to calculate the CTI. Multivariable logistic regression models were employed to evaluate the association between CTI and AF prevalence, and the dose–response relationship was assessed using restricted cubic spline (RCS) analysis. Furthermore, the association between CTI and AF risk was evaluated using the C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results Among the 2, 988 participants, CTI levels were significantly higher in the AF group compared to the non-AF group. In the fully adjusted model (adjusting for age, sex, BMI, blood pressure, glycemic indices, and lipid profiles), CTI was independently and positively associated with AF prevalence (OR 7.27, 95% CI 5.87–9.00; P 0.001). Restricted cubic spline analysis revealed a significant linear dose-response relationship between CTI and AF risk. Furthermore, adding CTI to the reference clinical model improved the C-index from 0.6828 to 0.7985, accompanied by significant improvements in the net reclassification improvement (NRI: 0.5609) and integrated discrimination improvement (IDI: 0.7182) (all P 0.001). Conclusions A higher CTI, reflecting a state of combined elevated inflammation and insulin resistance, is significantly and independently associated with an increased prevalence of atrial fibrillation. This novel index may serve as a valuable and integrative biomarker for identifying individuals at high risk for AF.

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Cite This Study

Liu et al. (2026) conducted a cross-sectional in Atrial Fibrillation (n=2,988). C-reactive protein to triglyceride-glucose index (CTI) vs. Participants without atrial fibrillation was evaluated on Association between CTI and AF prevalence (OR 7.27, 95% CI 5.87–9.00, p=<0.001). A higher CTI is significantly and independently associated with an increased prevalence of atrial fibrillation, with an odds ratio of 7.27.

synapsesocial.com/papers/69b64c33b42794e3e660d8dfhttps://doi.org/10.3389/fendo.2026.1790373
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