The C-Reactive Protein–Triglyceride–Glucose Index as a Biomarker of Metabolic Dysfunction-Associated Steatotic Liver Disease: Results from the Population-Based Italian NUTRI-HEP Cohort

Background/Objectives: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is rapidly becoming one of the main Non-communicable Chronic Diseases (NCDs) in the global population. It is based on the presence of hepatic steatosis linked to other metabolic alterations. Currently, the gold standard techniques to evaluate hepatic steatosis are liver biopsy and hepatic ultrasound examinations (FIBROSCAN®). However, liver biopsy is an invasive technique and ultrasonic examination is expensive. Therefore, the search for a possible low-cost and non-invasive examination has highlighted the C-reactive protein-triglycerides-glucose index (CTI index) as a possible alternative. This index has already been shown to be associated with cancer survival and with cardiovascular diseases and stroke in previous studies and was found to be predictive for the development of several cardiovascular diseases and stroke incidence. This analysis aimed to investigate the possible association between CTI and MASLD in a southeastern Italian cohort. Methods: This study included 1297 subjects from the NUTRI-HEP project: 629 (48.5%) were affected by MASLD and 668 (51.5%) were not. The CTI index was calculated using the formula proposed by Ruan et al. and was used as both a continuous and a categorical variable. Four logistic regression models were fitted using MASLD as the outcome and the CTI index as the exposure. They were adjusted for several covariates. Results: All logistic regression models indicated a positive association between the CTI index and MASLD development. Focusing on Model 4, using Q1 as a reference, the Odds Ratios were 1.48 (95% C.I. 1.00; 2.17, p = 0.049), 2.06 (95% C.I. 1.38; 3.08, p < 0.001) and 3.62 (95% C.I. 2.32; 5.64, p < 0.001). Conclusions: This study highlights a strong association between MASLD and the CTI index. This association strengthens the role of CTI in predicting the onset and development of MASLD.