A recent study published in Medicine (Baltimore) has identified the C-reactive protein–triglyceride glucose index (CTI) as a promising biomarker that is significantly and independently associated with both osteoarthritis (OA) prevalence and all-cause mortality in affected patients. The study highlights that CTI outperforms traditional biomarkers such as C-reactive protein (CRP) and the triglyceride-glucose (TyG) index when used individually, suggesting that a combined metabolic and inflammatory marker may provide better clinical insight.
CTI is an emerging composite biomarker that integrates systemic inflammation and insulin resistance, two key processes underlying many chronic diseases. It has already been explored in conditions such as cardiovascular disease, cerebrovascular events, and cancer-related outcomes, where higher CTI levels have been linked to increased risk. Earlier findings have also associated elevated CTI with hypertension-related stroke and depressive symptoms, reinforcing its role as a marker that bridges metabolic and inflammatory pathways.
In the present study, researchers analyzed data from 10,372 participants enrolled in the National Health and Nutrition Examination Survey between 1999 and 2018. Using multivariate logistic regression, Cox regression, restricted cubic spline functions, and receiver operating characteristic curve analyses, they evaluated the relationship between CTI and osteoarthritis prevalence as well as all-cause mortality. The results showed that CTI was significantly associated with OA prevalence in the fully adjusted model, with an odds ratio of 1.35 and a highly significant P value. CTI also demonstrated superior predictive performance compared to CRP or TyG index alone.
Among the 1,064 OA patients identified in the cohort, elevated CTI levels were independently associated with increased all-cause mortality, with a hazard ratio of 1.24. A clear dose-response relationship was observed, indicating that higher CTI levels corresponded to greater mortality risk. These findings suggest that CTI not only reflects disease presence but may also provide prognostic information regarding patient outcomes.
Supporting evidence from another study by Xie et al. using NHANES data from 2005 to 2010 further strengthens the relevance of CTI. That study demonstrated a significant and independent nonlinear association between CTI and rheumatoid arthritis risk, consistent across sex and ethnic groups and more pronounced in individuals without diabetes. Additional analyses indicated that body mass index partially mediated this relationship, suggesting that CTI captures both direct inflammatory effects and indirect metabolic influences.
OA is a common degenerative joint disease increasingly recognized as being driven not only by mechanical factors but also by chronic inflammation and metabolic dysregulation. The identification of CTI as a readily accessible and noninvasive biomarker offers potential clinical value in early risk stratification, prognostic assessment, and the development of personalized intervention strategies, particularly for high-risk populations. However, the authors note that causality cannot be established from these observational and cross-sectional data and emphasize the need for future prospective and interventional studies to confirm its role and evaluate its utility in guiding prevention and treatment strategies.
References
- Xie R, Long J, Liu D. C-reactive protein-triglyceride glucose index is a reliable biomarker for osteoarthritis: A cross-sectional study based on NHANES 1999-2018. Medicine (Baltimore). 2026 Apr 17;105(16):e48314.
- Xie H, Liu Q, Xu X, Wu Y, Liu J, Lin D, Zhou M, Chen Z, Gao F, Cai L. Nonlinear Association Between the C-Reactive Protein-Triglyceride-Glucose Index and Rheumatoid Arthritis Risk: The Mediating Role of Body Mass Index. Mediators Inflamm. 2025 Nov 10;2025:8729780.