AI Insight
This retrospective study of 316 acute pancreatitis patients found that two biomarkers—the triglyceride-glucose (TyG) index and C-reactive protein-to-albumin ratio (CAR)—were independently associated with progression to severe acute pancreatitis (SAP) and 28-day mortality. Patients with TyG index values of 12.12 or higher, or CAR values of 3.72 or higher, showed significantly increased risk of severe disease and death. Both markers demonstrated good predictive performance with areas under the curve of 0.701 and 0.793 respectively after internal validation.
Why it matters
These easily calculated biomarkers could help clinicians identify high-risk acute pancreatitis patients early in their hospital course, enabling more aggressive monitoring and treatment before severe complications develop. The use of routine laboratory values makes this approach practical and cost-effective for implementation in emergency and hospital settings.
Understand the Science
by Qiuhui Tian, Yinyin Zhang, Xiaolin Zhu, Ting Luo, Qiumei Cao, Yu Liu
Background
Severe acute pancreatitis (SAP) is characterized by rapid development, complex clinical changes, and a high mortality rate. Early identification of patients with acute pancreatitis that has the potential to become severe is important for optimizing clinical outcomes. However, at present, there is no effective prediction or evaluation tool. This study aimed to determine the ability of the triglyceride–glucose (TyG) index and C-reactive protein-to-albumin ratio (CAR) to predict the risk of progression to SAP and 28-day mortality.
Methods
This retrospective cohort study included 316 patients with a diagnosis of acute pancreatitis. Information on background characteristics, including sex, age, comorbidities, etiological factors, other relevant variables, and laboratory results was collected. The primary endpoints were progression to SAP and 28-day mortality in patients with SAP. Associations of the TyG index and CAR with the risk of SAP were assessed by logistic regression. Prediction performance was evaluated by receiver-operating characteristic curve analysis and internally validated via 1,000 bootstrap resamples with calibration. Cox regression and Firth’s penalized Cox regression were used to evaluate 28-day mortality. Survival was compared between groups using the Kaplan–Meier method.
Results
TyG index and CAR values were significantly higher in the SAP group than in the non-SAP group (both p < 0.001). After full adjustment for potential confounders, multivariate logistic regression, the TyG index (odds ratio 2.42, 95% CI 1.36–4.32, p = 0.003) and CAR (odds ratio 1.40, 95% CI 1.12–1.74, p = 0.003) were independently associated with SAP. The apparent areas under the curve for the TyG index and CAR for prediction of SAP were 0.702 and 0.793, respectively; following bootstrap internal validation, the optimism-corrected areas under the curve were 0.701 and 0.793, respectively, with optimism values below 0.05 in both cases and calibration curves demonstrating good agreement between predicted and observed probabilities. Firth’s penalized likelihood Cox regression revealed positive associations of elevated TyG index and CAR values with 28-day mortality in patients with SAP, with respective hazard ratios of 11.90 (95% CI 3.47–50.53) and 10.22 (95% CI 2.31–96.19). Kaplan–Meier survival analysis confirmed that clinical outcomes were significantly worse in patients with SAP and a TyG index ≥12.12 or CAR ≥ 3.72 (p < 0.001, log-rank test).
Conclusion
The TyG index and CAR were identified as independent predictors of progression from acute pancreatitis to SAP. High-risk thresholds (TyG index ≥12.12 and CAR ≥ 3.72) showed good prediction performance for 28-day mortality in patients with SAP, highlighting their value for early risk stratification. Nevertheless, these cut-off values require validation in prospective multicenter cohorts.