Review for 10.1186/s12876-025-03793-3 (2025)

Title: Triglyceride-glucose index and triglyceride-to-high-density lipoprotein cholesterol ratio
in predicting severity of acute pancreatitis: a cross-sectional clinical study
Version: 1 Date: 11 Feb 2025
Reviewer's report:
Dear Editor,
Thank you for the opportunity to review the manuscript entitled "Triglyceride-glucose index
and triglyceride-to-high-density lipoprotein cholesterol ratio in predicting severity of acute
pancreatitis: a cross-sectional clinical study." The study provides insightful data on the predictive
value of the triglyceride-glucose (TyG) index and triglyceride-to-high-density lipoprotein
cholesterol (TG/HDL-C) ratio for severe acute pancreatitis (SAP). The findings suggest that
the TyG index is a valuable biomarker for predicting SAP, which could be instrumental in
clinical settings for early diagnosis and intervention. The study's methodology is clear and well-
executed, providing strong statistical evidence supporting the association between these indices
and SAP.
Statistical Comments:
Justification for Statistical Methods: The statistical approach used in this study, including
Spearman’s correlation, logistic regression, and ROC curve analysis, is appropriate. However,
the authors could provide more context on how multivariate logistic regression was performed,
particularly when adjusting for confounders such as age, sex, BMI, diabetes, and hypertension. It
would be useful to understand why certain variables were included or excluded from the models,
and the potential impact on the results.
Clarity on ROC Curve Interpretation: The ROC curve analysis reveals the diagnostic ability of
the TyG index and TG/HDL-C ratio, with TyG showing a higher AUC. While the results are
compelling, a more thorough explanation of how the AUC translates into clinical practice would
be beneficial. For instance, what is the clinical significance of the cutoff value of 8.39 for TyG
index, and how should clinicians interpret the sensitivity and specificity values?
Analysis of Other Potential Confounders: While the authors adjusted for key confounders such
as age, sex, and comorbidities, it would be helpful to mention whether any additional factors
(e.g., diet, medication use, or other metabolic disorders) could have influenced the results. Did
the authors assess the impact of these factors in their analysis? Additionally, exploring whether
there is any effect modification by these variables could further strengthen the findings.
Clinical Comments:
Clinical Implications of TyG Index in SAP: The study’s findings underscore the potential of
the TyG index in predicting severe acute pancreatitis, which could help clinicians identify high-
risk patients for early intervention. The authors should further elaborate on the practical use
of TyG index in clinical practice. For example, could TyG be used in routine screening or as
part of a risk stratification tool to guide decision-making regarding early treatment or intensive
monitoring for patients with AP?
Comparison with Other Biomarkers: The manuscript compares the TyG index and TG/HDL-
C ratio but does not fully explore the advantages and disadvantages of each biomarker. While
TyG appears to be more effective, the authors could discuss specific scenarios in which one
marker might be preferred over the other. For instance, in resource-limited settings, could the
simpler TG/HDL-C ratio be an adequate alternative? How do these biomarkers compare to more
established clinical indices, such as APACHE II or Ranson's score, in predicting SAP?
Impact of Lifestyle Modifications: Given the association between insulin resistance (IR) and
SAP, the authors should explore whether lifestyle modifications aimed at improving IR (e.g.,
weight loss, dietary changes, physical activity) could alter the predictive value of the TyG
index. Are there any studies that have examined how lifestyle interventions may influence the
TyG index and reduce the severity of pancreatitis? This would provide a more comprehensive
understanding of how to manage SAP risk in the long term.
Relationship between TyG Index and Other Disorders: The manuscript effectively focuses on
the association between the TyG index and acute pancreatitis. However, the authors should
also mention the broader implications of the TyG index, particularly its relationship with other
metabolic and cardiovascular disorders. Emerging research suggests that TyG is a valuable
marker not only for insulin resistance but also for conditions like type 2 diabetes, metabolic
syndrome, and cardiovascular diseases, which often coexist with acute pancreatitis.To enhance
the discussion, the authors are encouraged to cite the following recent study that explores the
relationship between TyG and various metabolic disorders:
DOI: 10.1186/s12933-024-02392-y
This article provides valuable insights into how TyG is implicated in the pathophysiology of
these diseases, which could deepen the understanding of its role in predicting pancreatitis and
other related conditions.