Inflammatory markers mediate the association between alternative adiposity indices and mortality in patients with rheumatoid arthritis: data from NHANES 1999–2018

作者：Feng Luo, Jia-jie Guo, Xue-mei Yuan, Zhou Heng, Qiu-Yi Wang, Chang‐Ming Chen, Xueming Yao, Wukai Ma · 发表于：Lipids in Health and Disease · 年份：2025 · DOI：10.1186/s12944-025-02584-9 · 被引用次数：7 · 研究领域：Rheumatoid Arthritis Research and Therapies、Adipokines, Inflammation, and Metabolic Diseases、Inflammatory Biomarkers in Disease Prognosis

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease with increasing mortality worldwide. Traditional obesity indicators inadequately predict the mortality risk in this population. Thus, the research aimed to evaluate new obesity indicators to explore their close association with RA mortality. METHODS: This study analyzed 101,316 National Health and Nutrition Examination Survey participants (1999-2018) to evaluate alternative adiposity indices for RA mortality prediction. Missing data were imputed using the random forest method. Key covariates were selected using the Boruta algorithm and weighted univariate Cox regression. Multivariable-adjusted models generated hazard ratios (95% confidence interval), validated by time-dependent receiver operating characteristic curves and Harrell's C-index. Survival patterns were assessed with restricted cubic splines (RCS) and Kaplan-Meier curves. Threshold effects and robustness were analyzed via segmented Cox models and sensitivity analyses. Extreme gradient boosting (XGBoost) identified A Body Shape Index (ABSI) as the strongest predictor. RESULTS: Among the 1,266 individuals, 299 deaths occurred during follow-up (190 all-cause, 59 cardiovascular, 50 cancer). ABSI predicted the 5-, 10-, and 20-year mortality (area under the curve: 0.823, 0.801, 0.752, respectively) and outperformed other indices in the Harrell's C-index. Weighted multivariable Cox regression linked higher ABSI × 100 values with increased mortali...