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Published on: January 28, 2020
Association of Triglyceride-to-HDL-C Ratio, Triglyceride-Glucose Index, and Inflammatory Biomarkers with Mortality in
Nilgün Şahin1, Semih Aydemir2, Nazan Has Selmi2
1Department of Anesthesiology and Reanimation, Ankara Guven Hospital, 06540 Ankara, Türkiye.
Insights
The triglyceride-glucose index (TGI) and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio predict mortality in ICU sepsis patients. Combining these metabolic markers with inflammatory biomarkers like pan-immune-inflammation value (PIV) improves risk prediction.
Area of Science:
- Critical Care Medicine
- Metabolic Syndrome
- Biomarkers in Sepsis
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Early identification of high-risk sepsis patients is crucial for timely intervention and improved outcomes.
- The prognostic value of metabolic indices and inflammatory markers in sepsis mortality remains an area of active research.
Purpose of the Study:
- To investigate the prognostic significance of the triglyceride-glucose index (TGI) and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio in predicting short-term mortality among ICU patients with sepsis.
- To evaluate the predictive accuracy of inflammatory biomarkers, including the pan-immune-inflammation value (PIV), in this patient population.
- To assess whether combining these metabolic and inflammatory indices with conventional clinical scores enhances prognostic accuracy.
Main Methods:
- A retrospective cohort study of 600 adult ICU patients diagnosed with sepsis (Sepsis-3 criteria).
- Collection of clinical, biochemical, and hematological data within 24 hours of ICU admission.
- Analysis of metabolic indices (TGI, TG/HDL-C) and inflammatory markers (NLR, SII, PIV), with 28-day mortality as the primary outcome, using ROC analysis and multivariable logistic regression.
Main Results:
- Non-survivors had significantly higher TGI, TG/HDL-C, NLR, SII, and PIV compared to survivors (p < 0.001).
- TGI (AUC=0.75), TG/HDL-C (AUC=0.72), and PIV (AUC=0.78) showed good discriminative power for 28-day mortality.
- TGI > 8.95, TG/HDL-C > 3.95, and PIV > 260 were independent predictors of mortality. Integrating TGI and PIV with SOFA score improved prognostic performance (ΔAUC=+0.04).
Conclusions:
- TGI and TG/HDL-C are independent predictors of short-term mortality in septic ICU patients, indicating the role of metabolic dysregulation.
- PIV demonstrated predictive ability comparable to conventional severity scores.
- Combining metabolic and inflammatory biomarkers with clinical indices can improve early risk stratification and guide personalized sepsis management.
Abstract:
Background/Objectives: This study aimed to investigate the prognostic significance of the triglyceride-glucose index (TGI), triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, and inflammatory biomarkers in predicting short-term mortality among intensive care unit (ICU) patients with sepsis. Additionally, this study evaluated whether combining these indices with conventional clinical scores improves prognostic accuracy. Methods: This retrospective cohort study included 600 adult ICU patients diagnosed with sepsis according to Sepsis-3 criteria between January 2020 and April 2025. Clinical, biochemical, and hematological data were collected within the first 24 h of ICU admission. Metabolic indices (TGI, TG/HDL-C) and inflammatory markers (neutrophil-to-lymphocyte ratio [NLR], systemic immune-inflammation index [SII], and pan-immune-inflammation value [PIV]) were analyzed. The primary outcome was 28-day mortality. Receiver operating characteristic (ROC) analyses, Kaplan-Meier survival curves, and a multivariable logistic regression model were applied to determine prognostic performance. Results: Non-survivors exhibited significantly higher levels of TGI, TG/HDL-C, NLR, SII, and PIV compared to survivors (all p < 0.001). In ROC analysis, TGI (AUC = 0.75, 95% CI: 0.71-0.79), TG/HDL-C (AUC = 0.72, 95% CI: 0.68-0.76), and PIV (AUC = 0.78, 95% CI: 0.74-0.82) demonstrated good discriminative power for predicting 28-day mortality. Multivariate logistic regression identified TGI > 8.95 (OR = 1.44, 95% CI: 1.19-1.74, p < 0.001), TG/HDL-C > 3.95 (OR = 1.31, 95% CI: 1.08-1.59, p = 0.005), and PIV > 260 (OR = 1.49, 95% CI: 1.22-1.82, p < 0.001) as independent predictors of mortality. Integrating TGI and PIV with the SOFA score improved prognostic performance (ΔAUC = +0.04). Conclusions: Both TGI and TG/HDL-C are independent predictors of short-term mortality in septic ICU patients, reflecting the contribution of metabolic dysregulation to disease severity. The PIV demonstrated comparable predictive ability to conventional severity scores. Combining metabolic and inflammatory biomarkers with established clinical indices may enhance early risk stratification and guide personalized management strategies in sepsis.
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