Pretransplant demographic characteristics and laboratory data
The pretransplant demographic characteristics and laboratory data of the study subjects are summarized in Table 1. Of the 191 subjects, the mean age was 43.12±11.87 years with 67.54% (129/191) male. Patients with PTDM or DM were older and had higher 2h-BG, higher BMI and higher HDL-C than nondiabetic patients. Patients with PTDM had the highest proportion of tacrolimus (FK506) usage and patients with DM had the highest proportion of overweight. BP, smoking and drinking history, TC, TG, LDL-C, FBG, SCr, eGFR, ALB, ALT, AST, γ-GT and HB were compared between the three groups but no significant differences were found.
Table 1. Comparisons of demographic characteristics of each group pretransplant.
Variables
|
Total (n=191)
|
NC (n=145)
|
PTDM (n=23)
|
DM (n=23)
|
P
|
Age (years)
|
43.12±11.87
|
40.57±11.02
|
47.91±10.23 ab
|
54.35±10.89 a
|
0.003
|
Male (n, %)
|
129 (67.54)
|
95 (65.52)
|
19 (82.61)
|
15 (65.22)
|
0.260
|
FK506 (n, %)
|
134 (70.16)
|
116 (80)
|
13 (56.52) ab
|
5 (21.74) a
|
<0.001
|
BMI (kg/m2)
|
21.51±3.17
|
20.87±2.98
|
23.53±2.54 a
|
23.52±3.31 a
|
<0.001
|
Overweight (n, %)
|
20 (10.47)
|
9 (6.21)
|
4 (17.39)
|
7 (30.43) a
|
0.001
|
SBP (mmHg)
|
142.93±20.34
|
141.23±18.98
|
145.65±22.18
|
150.96±25.04
|
0.330
|
DBP (mmHg)
|
87.95±13.20
|
89.23±13.10
|
85.81±12.62
|
82.22±13.10
|
0.218
|
HBP (n, %)
|
187 (97.91)
|
144 (99.31)
|
19 (82.61)
|
23 (100)
|
<0.001
|
Smoking (n, %)
|
61 (31.94)
|
45 (31.03)
|
6 (26.09)
|
10 (43.48)
|
0.403
|
Drinking (n, %)
|
34 (17.80)
|
20 (13.79)
|
3 (13.04)
|
6 (26.09)
|
0.300
|
TC (mmol/L)
|
4.39±1.25
|
4.38±1.25
|
4.51±1.05
|
4.37±1.47
|
0.653
|
TG (mmol/L)
|
2.14±1.75
|
1.95±1.47
|
2.58±1.59
|
2.87±2.97
|
0.231
|
HDL-C (mmol/L)
|
1.00±0.29
|
1.03±0.30
|
0.90±0.21 a
|
0.94±0.30 a
|
0.043
|
LDL-C (mmol/L)
|
2.39±0.82
|
2.40±0.83
|
2.47±0.80
|
2.24±0.76
|
0.694
|
FBG (mmol/L)
|
5.37±2.15
|
4.80±0.76
|
5.11±0.88
|
9.24±4.18
|
0.315
|
2h BG (mmol/L)
|
6.54±1.97
|
5.83±1.04
|
8.98±1.73 a
|
12.35±3.59 ab
|
0.035
|
SCr (μmol/L)
|
885.77±289.67
|
870.90±278.65
|
965.48±327.56
|
899.83±317.51
|
0.147
|
eGFR (ml/min/1.73m2)
|
5.90±2.41
|
6.07±2.54
|
5.18±1.96
|
5.54±1.87
|
0.101
|
ALB (g/L)
|
41.09±5.60
|
41.29±5.43
|
39.06±5.71
|
41.86±6.32
|
0.075
|
ALT (U/L)
|
17.62±11.64
|
17.62±11.87
|
18.13±11.51
|
17.13±10.74
|
0.846
|
AST (U/L)
|
17.64±8.12
|
17.62±8.14
|
17.78±7.93
|
17.61±8.55
|
0.930
|
γ-GT (U/L)
|
26.68±19.27
|
26.86±21.16
|
24.35±9.10
|
27.87±14.07
|
0.564
|
HB (g/L)
|
112.49±19.78
|
114.65±18.85
|
106.30±13.81
|
105.09±27.11
|
0.058
|
BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; TC: total cholesterol; TG: total cholesterol; HDL-C: high-density lipoprotein cholesterol; LDL-C: high-density lipoprotein cholesterol; FBG: fasting blood glucose; 2h BG: 2 hours blood glucose; SCr: serum creatinine; eGFR: estimated glomerular filtration rate; ALB: albumin; ALT: alanine aminotransferase; AST: glutamine aminotransferase; γ-GT: gamma-glutamyl transferase; HB: hemoglobin.
a P <0.05 compared with NC; b P <0.05 compared with DM.
The predictive accuracy of the studied markers for PTDM
In the overall subjects, four markers including TyG-BMI, TyG, TG/HDL-C and non-HDL-C/HDL-C were compared among the NC group, PTDM group and DM group at pretransplant, 1-month posttransplant and 3-month posttransplant (Table 2). A higher TyG-BMI was found in the PTDM group and DM group than in the NC group from pretransplant to 3-month posttransplant (P< 0.01). TyG and non-HDL-C/HDL-C were markedly higher in the PTDM group and DM group at pretransplant and 3-month posttransplant (P <0.05), but not at 1-month posttransplant, while no significant difference was found in the value of non-HDL-C/HDL-C among the three groups at all three timepoints.
Table 2 Comparisons of the markers in each group pretransplant and posttransplant.
Group
|
Marker
|
Time point
|
|
|
|
|
|
Overall
|
|
|
Total (n=191)
|
NC (n=145)
|
PTDM (n=23)
|
DM (n=23)
|
P
|
TyG-BMI
|
Pretransplant
|
191.32±39.44
|
182.28±33.97
|
214.88±30.06 a
|
224.78±51.86 a
|
<0.001
|
1m posttransplant
|
182.21±31.58
|
176.06±28.54
|
200.08±25.13 a
|
203.09±40.14 a
|
0.001
|
3m posttransplant
|
184.45±30.69
|
178.49±28.38
|
204.78±23.50 a
|
201.91±36.09 a
|
<0.001
|
TyG
|
Pretransplant
|
8.85±0.77
|
8.70±0.67
|
9.11±0.56 a
|
9.47±1.10 a
|
0.010
|
1m posttransplant
|
8.97±0.57
|
8.88±0.48
|
9.12±0.54
|
9.35±0.87
|
0.152
|
3m posttransplant
|
9.03±0.48
|
8.97±0.43
|
9.22±0.36 a
|
9.24±0.71 a
|
0.019
|
TG/HDL-C
|
Pretransplant
|
2.44±2.34
|
2.15±2.00
|
3.09±2.00
|
3.58±3.86 a
|
0.134
|
1m posttransplant
|
1.92±1.25
|
1.80±1.12
|
2.17±1.45
|
2.42±1.68
|
0.582
|
3m posttransplant
|
1.87±0.98
|
1.83±0.93
|
2.13±0.87
|
1.86±1.31
|
0.383
|
Non-HDL-C/HDL-C
|
Pretransplant
|
3.59±1.55
|
3.44±1.53
|
4.12±1.02 a
|
3.98±1.96 a
|
0.029
|
1m posttransplant
|
3.50±1.47
|
3.35±1.41
|
3.88±1.12
|
4.12±1.89
|
0.104
|
3m posttransplant
|
3.07±1.19
|
2.97±1.08
|
3.67±1.12 a
|
3.09±1.69 a
|
0.040
|
FK506
|
|
|
Total (n=134)
|
NC (n=113)
|
PTDM (n=16)
|
DM (n=5)
|
P
|
TyG-BMI
|
Pretransplant
|
187.42±35.69
|
182.74±34.27
|
217.59±31.69 a
|
196.58±36.98 a
|
<0.001
|
1m posttransplant
|
179.90±30.15
|
176.90±29.98
|
202.13±25.57 a
|
176.47±19.19
|
0.002
|
3m posttransplant
|
181.88±29.51
|
178.72±28.61
|
209.31±24.93 ab
|
173.23±22.83
|
<0.001
|
TyG
|
Pretransplant
|
8.78±0.71
|
8.70±0.70
|
9.20±0.56 a
|
9.20±0.81 a
|
0.008
|
1m posttransplant
|
8.97±0.52
|
8.92±0.49
|
9.17±0.49
|
9.51±0.75
|
0.061
|
3m posttransplant
|
9.03±0.46
|
8.98±0.44
|
9.34±0.29 a
|
9.32±0.85 a
|
0.001
|
TG/HDL-C
|
Pretransplant
|
2.32±2.15
|
2.17±2.16
|
3.37±2.09 a
|
2.32±1.57 a
|
0.036
|
1m posttransplant
|
1.98±1.27
|
1.88±1.15
|
2.35±1.65
|
3.15±1.92 a
|
0.159
|
3m posttransplant
|
1.93±0.96
|
1.86±0.97
|
2.39±0.89
|
1.99±0.92
|
0.054
|
Non-HDL-C/HDL-C
|
Pretransplant
|
3.64±1.51
|
3.52±1.54
|
4.26±1.05 a
|
4.32±1.59
|
0.065
|
1m posttransplant
|
3.50±1.44
|
3.39±1.44
|
3.83±1.11
|
4.88±1.79 a
|
0.253
|
3m posttransplant
|
3.06±1.11
|
2.94±1.07
|
3.78±0.97 a
|
3.53±1.58 a
|
0.007
|
CsA
|
|
|
Total (n=57)
|
NC (n=32)
|
PTDM (n=7)
|
DM (n=18)
|
P
|
TyG-BMI
|
Pretransplant
|
200.49±46.15
|
180.63±33.34
|
208.68±27.52
|
232.61±53.47 a
|
0.101
|
1m posttransplant
|
187.64±34.37
|
173.10±22.89
|
195.40±25.35
|
210.48±41.62 a
|
0.178
|
3m posttransplant
|
190.29±32.73
|
177.70±27.97
|
195.72±18.72
|
209.88±35.40 a
|
0.154
|
TyG
|
Pretransplant
|
9.00±0.88
|
8.71±0.56
|
8.92±0.53
|
9.54±1.18 a
|
0.762
|
1m posttransplant
|
8.96±0.68
|
8.76±0.42
|
9.01±0.66
|
9.31±0.92
|
0.747
|
3m posttransplant
|
9.02±0.51
|
8.92±0.37
|
8.98±0.39
|
9.21±0.69
|
0.974
|
TG/HDL-C
|
Pretransplant
|
2.72±2.74
|
2.10±1.33
|
2.43±1.74
|
3.94±4.26 a
|
0.959
|
1m posttransplant
|
1.77±1.21
|
1.52±0.95
|
1.75±0.81
|
2.22±1.60
|
0.881
|
3m posttransplant
|
1.72±1.00
|
1.69±0.77
|
1.61±0.58
|
1.82±1.42
|
0.984
|
Non-HDL-C/HDL-C
|
Pretransplant
|
3.47±1.66
|
3.18±1.49
|
3.78±0.93
|
3.88±2.08
|
0.383
|
1m posttransplant
|
3.51±1.53
|
3.17±1.31
|
3.98±1.22
|
3.91±1.92
|
0.206
|
3m posttransplant
|
3.08±1.38
|
3.07±1.14
|
3.43±1.45
|
2.97±1.74
|
0.543
|
a P <0.05 compared with NC; b P <0.05 compared with DM.
In view of the identified correlation between FK506 usage and PTDM, a subgroup analysis according to the type of calcineurin inhibitor (CNI) was conducted. Among the patients taking FK506, a higher TyG-BMI was affirmed in the PTDM group than in the NC group (P <0.01); nonetheless, no similar result was observed in the DM group. However, TyG, TG/HDL-C and non-HDL-C/HDL-C had less favorable predictive accuracy for PTDM. The TyG of the PTDM group had a higher value only at pretransplant and 3-month posttransplant, TG/HDL-C of the PTDM group had the highest value only at pretransplant, and non-HDL-C/HDL-C of the PTDM group had the highest value only at 3-month posttransplant. Conversely, in the patients taking cyclosporine (CsA), all the studied markers had no heterogeneity at any timepoint. In terms of time, from pretransplant to 3-month posttransplant, an increase in TyG was depicted in both the FK506 subgroup and CsA subgroup with a steeper slope in the FK506 subgroup, although without statistical significance (Figure 1). The changes in TyG-BMI, TG/HDL-C and non-HDL-C/HDL-C were closely analogous in the FK506 and CsA subgroups.
Among subjects with non-DM and PTDM, the values of indices were divided into three groups according to the trisection of pretransplant values, and then the incidences of PTDM were compared (Figure 2). The PTDM morbidity increased along quartiles. A high TyG-BMI at pretransplant, 1-month posttransplant and 3-month posttransplant was significantly associated with an increased risk of developing PTDM in all patients (P <0.01), and a similar result was observed in the FK506 subgroup (P <0.05).From the lowest TyG-BMI trisection quartile to the highest, at pretransplant, the incidence of PTDM increased from 1.79% to 26.79%in the overall patients and from 2.38% to 25.58% in the FK506 subgroup; while at 1-month posttransplant, the incidence of PTDM increased from 3.57% to 27.27%in the overall patients and from 2.33% to 26.83%in the FK506 subgroup. For TyG, when the value increased from the lowest trisection quartile to the highest, the incidence of PTDM increased from 5.08% to 20.37% at pretransplant and from 8.62% to 24.53% at 1-month posttransplantin the overall patients. However, in the FK506 subgroup, a favorable predictive efficacy of TyG for PTDM was determined at pretransplant and 3-month posttransplant, but not at 1-month posttransplant. In the FK506 subgroup, positive relationships were also found between TG/HDL-C and PTDM onset, because from the lowest TG/HDL-C trisection quartile to the highest, the incidence of PTDM increased from 0 to 26.83% at pretransplant and from 2.50% to 22.73% at 3-month posttransplant. A similar association was found between non-HDL-C/HDL-C and PTDM onset in the FK506 subgroup at pretransplant and 1-month posttransplant. In contrast, in the CsA subgroup, no association was verified between the studied markers and the incidence of PTDM.
Correlation analysis of the markers and PTDM
Subjects with non-DM and PTDM were the study objects of correlation analysis in our research. Direct receiver-operating characteristic (ROC) regression was implemented to further determine the discriminative power of the four markers to predict PTDM (Table 3). For the total patients, TyG-BMI at pretransplant, non-HDL-C/HDL-C at pretransplant and 1-month posttransplant had the highest sensitivity (82.61%), while TyG at 1-month posttransplant had the highest specificity (84.14%). In the FK506 subgroup, the highest sensitivity (100%) and the highest NPV (100%) were found in TyG-BMI at 3-month posttransplant, while the highest specificity (83.33%) and the highest ACC (81.15%) were found in non-HDL-C/HDL-C at 3-month posttransplant. In the CsA subgroup, a significant association was only shown between TyG-BMI and PTDM, and TyG-BMI at 3-month posttransplant depicted the highest PPV (41.67%). In the overall patients and FK506 subgroup, TyG-BMI, TyG, TG/HDL-C and non-HDL-C/HDL-C all showed diagnostic value for PTDM, except TG/HDL-C at 1-month posttransplant. The optimal cutoff values were 209.84 for TyG-BMI, 8.95 for TyG, 2.2 for TG/HDL-C and 3.54 for non-HDL-C/HDL-C at pretransplant in the overall subjects, the values of which were very close to that in the FK506 subgroup. Comparisons of the area under the curves (AUCs) of the four markers (Figure 3) suggested that TyG-BMI was the best diagnostic marker of PTDM in both the FK506 subgroup and CsA subgroup. In patients taking FK506, TyG at pretransplant and 3-month posttransplant, non-HDL-C/HDL-C at 3-month posttransplant can also be regarded as a good predictive factor of PTDM owing to their high AUCs (>0.7).
Table 3 Cutoff values with their corresponding sensitivity, specificity, AUC, Youden index, PPV, NPV and ACC of the markers.
|
Marker
|
time
|
Cutoff
|
Sensitivity (%)
|
Specificity (%)
|
AUC (95%CI)
|
Youden index
|
PPV (%)
|
NPV (%)
|
ACC (%)
|
P
|
Overall
|
TyG-BMI
|
pretransplant
|
209.84
|
65.22
|
80.00
|
0.766 (0.694-0.828)
|
0.4522
|
34.09
|
93.55
|
77.98
|
<0.001
|
1m posttransplant
|
182.73
|
82.61
|
65.52
|
0.749 (0.676-0.813)
|
0.4813
|
27.54
|
95.96
|
67.86
|
<0.001
|
3m posttransplant
|
198.09
|
71.43
|
75.54
|
0.762 (0.688-0.826)
|
0.4697
|
30.61
|
94.59
|
75.00
|
<0.001
|
TyG
|
pretransplant
|
8.95
|
60.87
|
66.90
|
0.674 (0.597-0.744)
|
0.2777
|
22.58
|
66.90
|
36.90
|
0.002
|
1m posttransplant
|
9.27
|
52.17
|
84.14
|
0.660 (0.583-0.731)
|
0.3631
|
34.29
|
91.73
|
79.76
|
0.017
|
3m posttransplant
|
9.06
|
71.43
|
58.99
|
0.665 (0.586-0.737
|
0.3042
|
20.83
|
93.18
|
60.63
|
0.007
|
TG/HDL-C
|
pretransplant
|
2.2
|
65.22
|
71.03
|
0.687 (0.611-0.756)
|
0.3625
|
26.16
|
92.79
|
70.24
|
<0.001
|
1m posttransplant
|
1.70
|
69.57
|
60
|
0.621 (0.543-0.694)
|
0.2957
|
21.62
|
92.55
|
61.31
|
0.057
|
3m posttransplant
|
2.10
|
57.14
|
70.50
|
0.619 (0.539-0.695)
|
0.2765
|
22.64
|
91.59
|
68.75
|
0.050
|
Non-HDL-C/HDL-C
|
pretransplant
|
3.54
|
82.61
|
59.31
|
0.658 (0.581-0.729)
|
0.4192
|
24.36
|
95.56
|
62.5
|
0.002
|
1m posttransplant
|
2.86
|
82.61
|
44.14
|
0.649 (0.572-0.721)
|
0.2675
|
19.00
|
94.12
|
49.40
|
0.007
|
3m posttransplant
|
3.79
|
52.38
|
82.01
|
0.689 (0.611-0.759)
|
0.3440
|
30.56
|
91.94
|
78.13
|
0.002
|
FK506
|
TyG-BMI
|
pretransplant
|
209.84
|
68.75
|
80.53
|
0.775 (0.693-0.844)
|
0.4928
|
33.33
|
94.79
|
79.07
|
<0.001
|
1m posttransplant
|
187.15
|
81.25
|
69.91
|
0.753 (0.669-0.824)
|
0.5116
|
27.66
|
96.34
|
71.32
|
<0.001
|
3m posttransplant
|
172.03
|
100.00
|
50.00
|
0.794 (0.711-0.862)
|
0.5000
|
20.59
|
100
|
55.74
|
<0.0011
|
TyG
|
pretransplant
|
8.75
|
81.25
|
53.10
|
0.701 (0.614-0.779)
|
0.3435
|
19.70
|
95.24
|
56.59
|
0.001
|
1m posttransplant
|
9.10
|
75.00
|
64.49
|
0.676 (0.588-0.756)
|
0.4049
|
23.53
|
94.87
|
66.67
|
0.021
|
3m posttransplant
|
9.14
|
85.71
|
59.26
|
0.733 (0.646-0.809
|
0.44972
|
21.43
|
96.97
|
62.30
|
<0.001
|
TG/HDL-C
|
pretransplant
|
2.2
|
75.00
|
72.57
|
0.748 (0.664-0.821)
|
0.4757
|
27.91
|
95.35
|
72.87
|
<0.001
|
1m posttransplant
|
2.11
|
62.50
|
70.80
|
0.628 (0.538-0.711)
|
0.3330
|
23.26
|
93.02
|
69.77
|
0.090
|
3m posttransplant
|
2.07
|
71.43
|
68.52
|
0.687 (0.596-0.767)
|
0.3995
|
22.73
|
94.87
|
68.85
|
0.003
|
Non-HDL-C/HDL-C
|
pretransplant
|
3.64
|
87.50
|
61.06
|
0.678 (0.590-0.757)
|
0.4856
|
24.14
|
97.18
|
64.34
|
0.003
|
1m posttransplant
|
2.93
|
81.25
|
45.13
|
0.632 (0.542-0.715)
|
0.2638
|
17.33
|
94.44
|
49.61
|
0.047
|
3m posttransplant
|
3.78
|
64.29
|
83.33
|
0.735 (0.648-0.811)
|
0.3440
|
33.33
|
94.74
|
81.15
|
<0.001
|
CsA
|
TyG-BMI
|
pretransplant
|
180.23
|
85.71
|
59.38
|
0.754 (0.591-0.878)
|
0.4509
|
31.58
|
95.00
|
64.10
|
0.006
|
1m posttransplant
|
182.69
|
85.71
|
68.75
|
0.768 (0.605-0.888)
|
0.5446
|
37.50
|
95.65
|
71.79
|
0.031
|
3m posttransplant
|
195.49
|
71.43
|
77.42
|
0.700 (0.530-0.838)
|
0.4885
|
41.67
|
92.31
|
76.32
|
0.042
|
TyG
|
pretransplant
|
9.23
|
42.86
|
81.25
|
0.589 (0.421-0.744)
|
0.2411
|
33.33
|
86.67
|
74.36
|
0.483
|
1m posttransplant
|
9.24
|
42.86
|
93.75
|
0.650 (0.480-0.795)
|
0.3661
|
60.00
|
88.24
|
84.62
|
0.277
|
3m posttransplant
|
8.58
|
100.00
|
22.58
|
0.525 (0.357-0.689
|
0.2258
|
22.58
|
100
|
36.84
|
0.847
|
TG/HDL-C
|
pretransplant
|
3.70
|
28.57
|
93.75
|
0.545 (0.378-0.705)
|
0.2232
|
50.00
|
85.71
|
82.05
|
0.736
|
1m posttransplant
|
1.27
|
85.71
|
59.38
|
0.652 (0.483-0.797)
|
0.4509
|
31.58
|
95.00
|
64.10
|
0.236
|
3m posttransplant
|
1.45
|
71.43
|
48.39
|
0.507 (0.340-0.673)
|
0.1982
|
23.81
|
88.24
|
52.63
|
0.957
|
Non-HDL-C/HDL-C
|
pretransplant
|
2.55
|
100.00
|
34.38
|
0.625 (0.456-0.775)
|
0.3438
|
25.00
|
100
|
46.15
|
0.207
|
1m posttransplant
|
3.5
|
71.43
|
68.75
|
0.705 (0.538-0.840)
|
0.4018
|
33.33
|
91.67
|
69.23
|
0.046
|
3m posttransplant
|
2.63
|
85.71
|
41.94
|
0.571 (0.401-0.730)
|
0.2765
|
25.00
|
92.86
|
50.00
|
0.567
|
PPV, positive predictive value; NPV, negative predictive value; ACC: accuracy rate.
Logistic regression analysis using trisector 1 as a reference group affirmed that the ORs of PTDM increased nonlinearly along with the trisectors of the four markers at pretransplant (Table 4). Specifically, at pretransplant, in the initial crude analysis (Model 1), the risk of PTDM was 20.89 times higher in subjects with the highest trisector TyG-BMI (95% CI: 14.95-29.20), 6.70 times higher in subjects in the highest trisector of TyG (95% CI: 5.25-8.54), 10.46 times higher in subjects in the highest trisector of TG/HDL-C (95% CI: 8.11-13.48), and 4.28 times higher in subjects in the highest trisector of non-HDL-C/HDL-C (95% CI: 3.51-5.21). The association between the studied markers and the incidence of PTDM remained significant after multivariate adjustment. After adjusting for smoking, drinking, BMI and HCV (Model 2), the highest ORs were obtained in the highest trisector of TyG-BMI (5.44, 95% CI:3.27-9.07), in the highest trisector of TyG (3.22, 95% CI: 2.47-4.20), in the highest trisector of TG/HDL-C (4.97, 95% CI: 3.76-6.56), and in the second trisector of non-HDL-C/HDL-C (2.25, 95%CI: 1.78-2.84). After adjusting for CNIs, TC, LDL-C, ALB, ALT, eGFR and Hb based on Model 2 (Model 3), significantly high ORs were still observed with a value of 3.25 (95%CI: 2.01-5.27) in the second trisector of TyG-BMI, 6.25 (95%CI: 4.30-9.09) in the highest trisector of TyG, 7.29 (95%CI: 4.91-10.83) in the highest trisector of TG/HDL-C, and 6.95 (95%CI: 4.37-11.04) in the highest trisector of non-HDL-C/HDL-C. The relationships between the studied markers and PTDM were still definite at 1-month and 3-month posttransplant regardless of whether the interference factors had been adjusted. After transplantation, the largest ORs of TyG-BMI and non-HDL-C/HDL-C were found at 1-month posttransplant, while the largest ORs of TyG and TG/HDL-C were found at 3-month posttransplant. At the early-stage posttransplant, the four studied markers had all been approved as independent predictors for PTDM.
Table 4 Odds ratios and 95% confidence intervals of the markers and incident PTDM (N = 191)
time
|
|
|
Model 1
|
P Value
|
Model 2
|
P Value
|
Model 3
|
P Value
|
pretransplant
|
TyG-BMI index
|
T1 (< 168.05)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (168.05-199.37)
|
8.26 (5.84-11.68)
|
<0.001
|
5.32 (3.36-8.41)
|
<0.001
|
3.25 (2.01-5.27)
|
<0.001
|
T3 (>199.37)
|
20.89 (14.95-29.20)
|
<0.001
|
5.44 (3.27-9.07)
|
<0.001
|
2.02 (1.07-3.81)
|
0.030
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
TyG index
|
T1 (< 8.55)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (8.55-9.05)
|
4.69 (3.66-6.00)
|
<0.001
|
2.89 (2.21-3.78)
|
<0.001
|
3.58 (2.48-5.17)
|
<0.001
|
T3 (>9.05)
|
6.70 (5.25-8.54)
|
<0.001
|
3.22 (2.47-4.20)
|
<0.001
|
6.25 (4.30-9.09)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
TG/HDL-C ratio
|
T1 (< 1.31)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (1.31-2.26)
|
3.79 (2.89-4.97)
|
<0.001
|
2.69 (2.01-3.59)
|
<0.001
|
3.35 (2.23-5.04)
|
<0.001
|
T3 (>2.26)
|
10.46 (8.11-13.48)
|
<0.001
|
4.97 (3.76-6.56)
|
<0.001
|
7.29 (4.91-10.83)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
non-HDL-C/HDL-C ratio
|
T1 (< 2.77)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (2.77-4.06)
|
1.96 (1.59-2.43)
|
<0.001
|
2.25 (1.78-2.84)
|
<0.001
|
3.29 (2.16-5.03)
|
<0.001
|
T3 (>4.06)
|
4.28 (3.51-5.21)
|
<0.001
|
1.71 (1.35-2.15)
|
<0.001
|
6.95 (4.37-11.04)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
1m posttransplant
|
TyG-BMI index
|
T1 (< 161.34)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (161.34-189.94)
|
3.90 (2.94-5.18)
|
<0.001
|
4.90 (3.56-6.73)
|
<0.001
|
3.00 (1.75-5.15)
|
<0.001
|
T3 (>189.94)
|
15.42 (11.78-20.19)
|
<0.001
|
18.37 (12.34-27.33)
|
<0.001
|
2.55 (1.41-4.62)
|
0.002
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
TyG index
|
T1 (< 8.73)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (8.73-9.16)
|
1.28 (1.03-1.59)
|
0.024
|
1.42 (1.14-1.78)
|
0.002
|
1.64 (1.19-2.26)
|
0.002
|
T3 (>9.16)
|
4.85 (4.02-5.86)
|
<0.001
|
6.14 (4.98-7.58)
|
<0.001
|
14.41 (9.94-20.89)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
TG/HDL-C ratio
|
T1 (< 1.25)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (1.25-2.03)
|
3.89 (3.07-4.92)
|
<0.001
|
4.79 (3.73-6.14)
|
<0.001
|
7.60 (5.02-11.49)
|
0.005
|
T3 (>2.03)
|
9.24 (7.32-11.65)
|
<0.001
|
7.70 (6.06-9.79)
|
<0.001
|
16.07 (10.82-23.87)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
non-HDL-C/HDL-C ratio
|
T1 (< 2.72)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (2.72-3.75)
|
4.64 (3.70-5.81)
|
<0.001
|
3.30 (2.58-4.23)
|
<0.001
|
6.74 (4.96-9.16)
|
<0.001
|
T3 (>3.75)
|
7.58 (6.02-9.54)
|
<0.001
|
4.56 (3.55-5.86)
|
<0.001
|
8.49 (6.15-11.71)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
3m posttransplant
|
TyG-BMI index
|
T1 (< 163.89)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (163.89-194.68)
|
6.90 (4.84-9.85)
|
<0.001
|
7.66 (5.20-11.30)
|
<0.001
|
2.36 (1.47-3.78)
|
<0.001
|
T3 (>194.68)
|
24.84 (17.65-34.95)
|
<0.001
|
33.14 (20.79-52.83)
|
<0.001
|
6.29 (3.67-10.80)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
TyG index
|
T1 (< 8.82)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (8.82-9.23)
|
2.30 (1.87-2.83)
|
<0.001
|
1.89 (1.52-2.34)
|
<0.001
|
1.49 (1.09-2.05)
|
0.013
|
T3 (>9.23)
|
3.50 (2.87-4.27)
|
<0.001
|
2.66 (2.16-3.28)
|
<0.001
|
3.97 (2.88-5.46)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
TG/HDL-C ratio
|
T1 (< 1.29)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (1.29-2.07)
|
2.22 (1.77-2.78)
|
<0.001
|
2.00 (1.58-2.53)
|
<0.001
|
1.58 (1.10-2.25)
|
0.012
|
T3 (>2.07)
|
5.80 (4.69-7.17)
|
<0.001
|
4.53 (3.63-5.64)
|
<0.001
|
5.54 (4.04-7.59)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
non-HDL-C/HDL-C ratio
|
T1 (< 2.55)
|
1 (References)
|
|
1 (References)
|
|
1 (References)
|
|
T2 (2.55-3.42)
|
4.60 (3.59-5.90)
|
<0.001
|
4.76 (3.66-6.19)
|
<0.001
|
5.95 (4.22-8.40)
|
<0.001
|
T3 (>3.42)
|
9.71 (7.58-12.44)
|
<0.001
|
7.43 (5.73-9.63)
|
<0.001
|
8.86 (5.96-13.16)
|
<0.001
|
P for trend
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
Model 1: adjusted for sex and age; Model 2: adjusted for sex, age, smoking, drinking, obesity, hypertension and viral hepatitis C; Model 3: Model 2 and further adjusted for CNIs, total cholesterol, low-density lipoprotein cholesterol, albumin, alanine aminotransferase, estimated glomerular filtration rate and hemoglobin.