The Advanced Lung Cancer Inflammation Index and Mortality in Patients with Cardiovascular-Kidney Metabolic Syndrome: Insights from NHANES.

BACKGROUND: The advanced lung cancer inflammation index (ALI) is a marker of inflammation, yet its prognostic value in cardiovascular-kidney-metabolic (CKM) syndrome has not been explored. This study examines the relationship between ALI and mortality risk in patients with CKM. METHODS: We analyzed data from 14,301 CKM patients in the National Health and Nutrition Examination Survey (1999–2018). We assessed ALI tertiles (Tertile 1–Tertile 3) using Cox regression, restricted cubic splines, Kaplan-Meier survival curves, and receiver operating characteristic curves. We also performed sensitivity analyses to confirm the robustness of our results. RESULTS: In a cohort of 14, 301 patients with CKM syndrome, 2,418 deaths from all causes, 765 cardio-cerebrovascular deaths, and 590 cancer-related deaths were recorded. After adjusting for potential confounders, the weighted multivariate Cox model showed that higher ALI was significantly associated with a reduced risk of all-cause and cardio-cerebrovascular mortality (all P < 0.001). However, a correlation between ALI scores and reduced cancer mortality was only observed in Tertile 2 for cancer mortality (P= 0.01). Smooth curve fitting revealed nonlinear correlations between ALI and mortality across CKM stages 0–4, 0–3, and 4 (log-likelihood ratio test P < 0.001). Stratified analyses identified significant interactions between age (P for interaction = 0.03) and smoking status (P for interaction < 0.001) with all-cause mortality, and between chronic kidney disease prognosis and cancer mortality (P for interaction = 0.03) in CKM syndrome patients. Receiver operating characteristic curves confirmed that ALI is a strong predictor of both short- and long-term all-cause, cardio-cerebrovascular, and cancer mortality. CONCLUSION: Our study shows that ALI is negatively correlated with all-cause, cardio-cerebrovascular, and cancer mortality within a certain range in patients with CKM syndrome. ALI is an effective prognostic predictor of mortality risk in individuals with CKM syndrome.