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: 08 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While several citations are provided for the background statements, a few additional references
to studies investigating the relationship between metabolic factors (like TyG index and
TG/HDL-C) and acute pancreatitis could strengthen the argument. This would help further
substantiate the existing gap in the literature that the study intends to address.
-The background could benefit from a more explicit statement of the hypothesis. Although it’s
clear that the study aims to explore the association between the TyG index and TG/HDL-C ratio
with SAP, emphasizing how this study fills a gap in current knowledge would help direct the
reader’s focus. For example, the hypothesis could highlight the lack of previous studies that
directly compare the predictive ability of these two indices in AP patients.
-While univariate and multivariate logistic regression analyses are mentioned, there is no
mention of the specific confounders that will be adjusted for. It would be helpful to specify
whether factors such as age, sex, comorbidities, or other clinical variables will be included in
the regression models to adjust for potential confounding effects.
-While imaging methods (ultrasound, CT, MRI) are mentioned, it would be valuable to specify
how imaging findings will be integrated into the analysis or severity classification. Are the
images used only for confirming diagnosis, or will they also contribute to assessing the severity
of AP?
-While the TyG index and TG/HDL-C ratio are the primary focus, the discussion could benefit
from a comparison with other known biomarkers of inflammation or metabolic dysfunction in
AP. Mentioning how the TyG index and TG/HDL-C ratio perform relative to other established
biomarkers (such as C-reactive protein, amylase, and lipase) could provide a broader context
for understanding their clinical utility.
-The study adjusts for several confounders (e.g., age, gender, BMI, comorbidities), but the
discussion does not go into detail about how these factors might influence the results. It could
be beneficial to discuss whether any of these confounders were unexpectedly strong predictors
of SAP or whether the associations remained robust across different subgroups (e.g., diabetes
vs non-diabetic patients).
-The discussion mentions that there was no significant statistical difference between the TG/
HDL-C ratio and SAP after adjustments, but it does not fully explain why this is the case.
Further exploration into why the TG/HDL-C ratio failed to reach statistical significance despite
its theoretical relevance could provide additional insights. This could include possible reasons
such as the need for a larger sample size, the possibility that the TG/HDL-C ratio is more
influenced by other confounders, or that the TyG index is simply a more comprehensive measure
of metabolic dysfunction.