Front Immunol. 2026 Sep 9;17:1937248. doi: 10.3389/fimmu.2026.1937248. eCollection 2026.
ABSTRACT
OBJECTIVE: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and triglyceride-glucose (TyG) index are used to evaluate the risk of coronary artery disease (CAD) or chronic kidney disease (CKD). However, there are limited reports on their role in CKD risk assessment among CAD patients. This study focuses on their linear/nonlinear correlations, threshold effects, and mediating effects with CKD risk strata (classified by KDIGO) among CAD patients to explore their interrelationships.
METHODS: This cross-sectional study enrolled 1,091 patients with chronic coronary syndrome (CCS), 166 patients with acute coronary syndrome (ACS), and 431 healthy controls (HC). Their complete blood count indices and glucose/lipid metabolism parameters were used to calculate the NLR/PLR (reflecting immuno-inflammation) and TyG index (reflecting insulin resistance), and their kidney biomarkers were used to evaluate the CKD risk strata based on KDIGO classification.
RESULTS: No significant differences were found between acute and chronic CAD patients in any observational indicators except urea (all P>0.05). As CKD risk strata increased, NLR (z=17.813, P<0.001), PLR (z=8.699, P<0.001), TyG (z=11.213, P<0.001), and insulin resistance (γ=0.471, P<0.001) rose progressively. After adjusting for sex, age, and disease, the NLR and PLR showed linear correlations with potential CKD (P for nonlinear=0.094 and 0.152), with no threshold effects (P for likelihood=0.113 and 0.890); in contrast, TyG showed a nonlinear correlation (P for nonlinear=0.003; Reference threshold=8.62) and a threshold-dependent effect (P for likelihood test<0.001; Inflection point=8.67). Among the three indicators, only the NLR and TyG significantly predicted all four CKD risk strata (NLR OR = 2.30, 2.34, 2.70, and 2.73; TyG OR = 3.80, 3.27, 3.48, and 11.98; all P<0.01). Finally, the NLR and TyG demonstrated a reciprocal mediating role in potential CKD, with their effects strengthening as risk strata increased (NLR Mediation=14.52%~30.16%; TyG Mediation=6.54%~27.07%; all P<0.001).
CONCLUSION: The NLR and TyG index may serve as potential inflammation-metabolism markers for predicting potential CKD in CAD patients. The reciprocal mediation of NLR and TyG index across CKD risk strata suggests that immuno-inflammation and insulin resistance are overlapping correlates of higher CKD likelihood, rather than fully independent predictors. Combining both indices may improve early identification of high-risk CKD patients and enable early intervention.
PMID:42780108 | PMC:PMC13597357 | DOI:10.3389/fimmu.2026.1937248