Association between advanced lung cancer inflammation index and all-cause and cardiovascular mortality among prediabetes patients: NHANES, 1999–2018

Background Prediabetes is a significant risk factor for type 2 diabetes and cardiovascular disease, yet effective prognostic tools are lacking. The Advanced Lung Cancer Inflammation Index (ALI), an emerging inflammatory marker, has shown prognostic value in various diseases. However, the role of ALI in prediabetic patients remains understudied. This study aims to evaluate the association between ALI and all-cause and cardiovascular disease (CVD) mortality in prediabetic patients, exploring its potential as a prognostic assessment tool. Methods This study utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. Multivariate Cox regression models were used to analyze the relationship between ALI and mortality risk. Their non-linear relationship was analyzed by restricted cubic spline analysis. Sensitivity analysis was constructed through stratified analysis and interaction analysis. Results The study incorporated a total of 16,670 patients. An increase in ALI was associated with a reduced risk of all-cause and CVD mortality in prediabetes patients. Compared to the lowest ALI quartile, the highest quartile showed a 30% reduction in all-cause mortality risk (HR = 0.70, 95%CI: 0.62–0.79) and a 44% reduction in CVD mortality risk (HR = 0.56, 95%CI: 0.44–0.73). In addition, there were L-shaped non-linear relationships between ALI and all-cause, CVD mortality in prediabetes patients. The inflection points were 40.50 and 37.35, respectively. For values below the inflection point, for every 10U increase in ALI, all-cause mortality risk decreased by 26%, and CVD mortality risk decreased by 32%. Beyond the inflection point, the effect weakened both all-cause and CVD mortality. Conclusion ALI is significantly negatively associated with all-cause and CVD mortality in prediabetic patients. ALI may serve as an effective tool for assessing long-term prognosis in prediabetic individuals.