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Discriminative Performance of the C-Reactive Protein–Triglyceride–Glucose Index for Endometriosis: A Case–Control Study

Year: 2026

Type: article

Abstract: Introduction: Endometriosis, a common gynecologic disorder, causes pain and fertility problems. Since laparoscopy, as a definitive diagnostic procedure, is considered invasive, finding reliable and noninvasive biomarkers is a clinical priority. This study evaluated the diagnostic performance of C-reactive protein–triglyceride–glucose index (CTI) for endometriosis. Materials and Methods: In this case–control study, 153 participants with surgically confirmed endometriosis and 112 participants without visible endometriosis at laparoscopy were included. Fasting glucose, triglycerides (TG), total cholesterol, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured, and CTI was calculated using a previously described formula. Receiver operating characteristic (ROC) analysis was carried out to assess diagnostic discrimination and identify an exploratory threshold for CTI cutoff. Multivariable logistic regression was used to assess the independent relationship between CTI and endometriosis. Nested models were also assessed to examine the incremental contribution of TG and glucose beyond CRP. Results: Women with endometriosis exhibited higher levels of TG, total cholesterol, ESR, CRP, and CTI than controls (all P< 0.001), whereas fasting glucose did not differ significantly between groups. CTI showed good discrimination for endometriosis, with an area under the ROC curve (AUC) of 0.900 (95% CI, 0.858– 0.942). An exploratory cutoff of 9.686 yielded a sensitivity of 92.16% and specificity of 83.93%. CTI was independently associated with endometriosis after adjustment for age, body mass index, systolic and diastolic blood pressure (adjusted OR per 0.5-unit increase, 2.598; 95% CI, 2.079– 3.245; P< 0.001). However, CTI’s discriminatory performance was not significantly different from CRP’s. (AUC 0.898; P=0.827). Addition of TG to a CRP-based model significantly improved model fit (P=0.007), whereas addition of glucose did not (P=0.095); the overall difference in AUCs across the nested models was not statistically significant (P=0.719). Conclusion: CTI showed good discrimination for endometriosis but did not significantly outperform CRP. It may serve as a complementary biomarker alongside clinical and imaging assessment. The infographic presents a study on endometriosis, highlighting CTI and CRP′s similar diagnostic performance. Sections include: Background - Endometriosis is linked to metabolic dysregulation. Methods - Case-control study with 153 endometriosis patients and 112 controls. Study Population - Groups compared for age and BMI; higher levels of TG, cholesterol, ESR, CRP and CTI in endometriosis (p less than 0.001). Diagnostic Performance - ROC analysis shows AUCs: CTI 0.900, CRP 0.898, ESR 0.846, TG 0.828. Key Finding - CTI and CRP have similar discriminative performance (DeLong p equal 0.8265). Conclusion - CTI shows high performance, similar to CRP, needing further validation. Visuals include uterus icons for groups, ROC curve plot and pathway icons showing inflammation, lipid dysregulation and glucose metabolism feeding into CTI. The layout follows a top-to-bottom reading order, structured by major sections.Graphical abstract summarizing the study population, methods, and diagnostic findings of a case–control study evaluating CTI in endometriosis. CTI showed good discriminatory performance, with no statistically significant difference in AUC compared with CRP. Keywords: endometriosis, C-reactive protein, triglycerides, erythrocyte sedimentation rate, C-reactive protein–triglyceride–glucose index

Source: International Journal of Women s Health

DOI: 10.2147/ijwh.s634374