Correlation Between Triglyceride Glucose Index And Severity Of Acute Pancreatitis

BackgroundAcute pancreatitis(AP)is one of the most common digestive system diseases in the world.Severe patients are often accompanied by persistent organ failure and infectious pancreatic necrosis,and the mortality rate can be as high as 30%.It poses a great threat to security and the national health care system.However,the valuable predictive tools and effective therapeutic drugs are limited.Therefore,early assessment of the severity of AP and screening of possible severe patients is significant.Triglyceride glucose index(TyG index)is a novel marker reflecting insulin resistance,which has been widely studied and proved to be closely related to the incidence of metabolic syndrome and adverse outcomes of cardiovascular and cerebrovascular events.However,few studies focused on the association between TyG index and acute pancreatitis.ObjectiveThis study aimed to investigate the correlation of TyG index with the prognosis and complications of acute pancreatitis,and to evaluate its predictive value for the severity of acute pancreatitis.MethodsBy consulting the inpatient electronic medical record system of the second hospital of Shandong University,through strict inclusion and exclusion criteria,a total of 353 inpatients diagnosed with AP from January 2018 to November 2021 were enrolled.Patients’ baseline data,laboratory parameters and related complications were collected retrospectively.First,according to the revised Atlanta classification criteria,based on the severity,the subjects included were divided into the severe group and non-severe group,the differences in baseline data,laboratory parameters and complications were compared between the two groups.Then according to the interquartile range of triglyceride glucose index(TyG index),patients were divided into four groups:lowest quartile(Q1 TyG<8.41mmol/L;n=87),second quartile(Q28.41≤TyG<9.26mmol/L;n=91),third quartile(Q3 9.26≤TyG<10.68mmol/L;n=86),highest quartile(Q4 TyG≥10.68mmol/L;n=89).Differences in the prognostic indicators of acute pancreatitis in each group were analyzed respectively.The calculation formula of TyG index is as follows:Ln[fasting triglyceride(mg/dL)×fasting plasma glucose(mg/dL)/2].SPSS software(version 22.0)was used for statistical analysis of the data,and binary logistic regression analysis was used to explore the independent influencing factors of severe acute pancreatitis.Medcalc software(version 19.6.4)was used to draw the receiver operating characteristic curve(ROC)to obtain the best cutoff value,the area under the curve(AUC)was used to evaluate the discrimination,and the Delong test was further applied to evaluate the predictive power of different models.The Hosmer-Lemeshow test was used to evaluate the regression model calibration.Results1.A total of 353 AP patients were included in this study,including 47 with SAP and 306 with NSAP.The hospital stays(22.51±14.20 days vs 9.99±5.24 days,P<0.001)and ICU admission rate(48.9%vs 1.0%,P<0.001)in the SAP group were significantly higher than those in the NSAP group.Compared with the NSAP group,the TyG index level in the SAP group was significantly higher(10.44±1.55 vs 9.33±1.44,P<0.001).The NLR,CRP,WBC,fasting blood glucose,triglyceride,TG/HDL-C and ApoB/A1 in the SAP group were also significantly higher than those in the NSAP group(P<0.05),while the serum calcium level was lower in the SAP group(P<0.05).Organ failure(OF),systemic inflammatory response syndrome(SIRS),acute peripancreatic fluid collection(APFC),acute necrotic collections(ANC),pleural effusion,lung infection,liver injury and ascites were higher(P<0.05)in SAP group.2.The Q1 and Q2 groups mainly included other etiologies and biliary acute pancreatitis,while the Q3 and Q4 groups were mainly composed of alcoholic acute pancreatitis(AAP)and hypertriglyceridemia acute pancreatitis(HTG-AP).Compared with the Q1 group,the proportion of severe acute pancreatitis(SAP),systemic inflammatory response syndrome(SIRS),organ failure(OF),and acute necrosis collections(ANC)in Q2,Q3,and Q4 groups were all significantly increased(P<0.05).The incidences of SIRS,APFC and lung infection in group Q4 were significantly higher than those in group Q2(P<0.05).3.TyG index were higher in patients with SIRS(10.12 vs 9.24),OF(10.28 vs 9.32),APFC(10.12 vs 9.29)and ANC(10.45 vs 9.43)than those without,all differences being significant(P<0.05).4.Binary logistic regression analysis showed that after adjusting for confounding factors,TyG index was an independent risk factor for SAP(OR 1.835,95%CI 1.379～2.441 P<0.001).When TyG index was combined with age(OR 1.027 95%CI 1.001～1.053),P=0.045),serum calcium(OR 0.039 95%CI 0.009-0.165,P<0.001),neutrophil-to-lymphocyte ratio(NLR)(OR 1.062 95%CI 1.017-1.109,P=0.007)to predict SAP,the AUC of model 2 was 0.823(95%CI 0.779～0.861,P<0.001),which was significantly higher than that of model 1 without TyG index(AUC=0.767 95%CI 0.720～0.811,P<0.001),and the AUC increased significantly(Z=2.295,P=0.022).5.The AUC of TyG in predicting SAP in HTG-AP and(or)AAP was 0.822(95%CI 0.752～0.880,P<0.001),when the best cut-off value was set at 11.81,the sensitivity and specificity were 68.42%and 87.79%,respectively.The AUC for predicting SAP in BAP was 0.864(95%CI 0.794-0.917,P<0.001),when the best cutoff value was set at 8.75,the sensitivity was 94.74%,the specificity was 78.95%.The AUC for predicting SAP in other etiologies was 0.885(95%CI 0.787～0.949,P<0.001),when the best cutoff value was set at 8.95,the sensitivity was 100%,the specificity was 63.93%.Conclusions1.TyG index,NLR and age are independent risk factors for severe acute pancreatitis.Serum calcium is an independent protective factor for severe acute pancreatitis.2.High levels of TyG index are closely related to the risk of severe acute pancreatitis and complications,suggesting a potential pathophysiological link between insulin resistance and acute pancreatitis.3.When TyG index predicts severe acute pancreatitis,it should be noted that different optimal cut-off values should be set in different etiological groups.4.The TyG index is expected to be a new predictive tool for the severity of acute pancreatitis,and its predictive performance needs to be further verified by future large-sample population studies.