Synergistic and mediating roles of the triglyceride-glucose index and stress hyperglycemia ratio in predicting in-hospital adverse events in acute aortic syndrome patients
Y Xin, Y M YangAbstract
Background
The prognostic significance of the triglyceride-glucose (TyG) index and stress hyperglycemia ratio (SHR) in patients with acute aortic syndrome (AAS) remains underexplored. This study aimed to evaluate the predictive value of TyG, SHR, and their combination for in-hospital aorta-related adverse events (AAEs) in AAS patients.
Methods
This large, single-center retrospective cohort study included 2,997 AAS patients. The composite endpoint was in-hospital AAEs, comprising all-cause mortality, aortic dissection rupture, acute myocardial infarction, and acute renal insufficiency. Logistic regression, restricted cubic spline regression, receiver-operating characteristic (ROC) analysis, and mediation analysis were employed to explore the associations between the indices and clinical outcomes.
Results
Overall, 264 (8.8%) cases of AAEs were recorded during hospitalization. Patients in the highest TyG group (≥ 8.92) and the highest SHR group (≥ 1.17) exhibited significantly increased odds of AAEs compared with those in the lowest respective groups (TyG: odds ratio [OR] 2.001, 95% CI 1.405, 2.851; SHR: OR 1.536, 95% CI 1.277, 1.847). Patients with both the highest TyG and highest SHR demonstrated the highest odds of AAEs (OR 2.605, 95% CI 1.825, 3.718). ROC analysis confirmed that the TyG-SHR combination model offered superior predictive power for AAEs compared to the basic model (AUC: 0.690 vs. 0.643, P = 0.002). Mediation analysis revealed that SHR significantly mediated the association between TyG and AAEs (mediation proportion: 34.34%, P < 0.001).
Conclusion
The combination of high TyG (≥ 8.92) and elevated SHR (≥ 1.17) is significantly associated with increased odds of in-hospital AAEs in AAS patients. Joint assessment of TyG and SHR may serve as a reliable and independent predictor of in-hospital adverse outcomes, offering potential value for early risk stratification and clinical decision-making in this high-risk population.