Data Sheet 1_Development and validation of a prediction model for cardiovascular–kidney–metabolic syndrome progression: a multicenter study.docx

BackgroundDysfunction of multiple systems significantly contributes to cardiovascular–kidney–metabolic syndrome (CKM). We aimed to use routine indicators to predict progression to CKM and to examine the influence of the liver metabolic axis on CKM progression.
MethodsThis study was a multicenter retrospective study. We developed a model using new lipid-metabolism indicators to predict progression to CKM. Model performance was evaluated using discrimination, calibration, and decision curve analysis (DCA). Further studies on patients with diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD) explored the link to CKM progression.
ResultsA total of 21,026 participants with CKM stages 1 or 2 at baseline. The model demonstrated robust discrimination, with AUCs of 0.718 (95% CI 0.704–0.730) in the 2016–2019 cohort, 0.727 (95% CI 0.714–0.740) in the 2020 cohort, and 0.747 (95% CI 0.711–0.777) in the 2021 validation cohort. The predicted-risk quartiles were 1.8, 7.6, 11.4, and 24.9%, respectively. Subgroup analyses confirmed stable discrimination across clinical subgroups and different centers. Exploratory analyses revealed that individuals with diabetes and MASLD had the highest risk of CKM progression (odds ratio [OR] 2.13, 95% CI 1.89–2.40).
ConclusionWe developed a reliable model that identifies individuals at risk of progressing to CKM in the real world. Our results also suggest the liver metabolism axis may be crucial in CKM deterioration.