Ability of the triglyceride–glucose index and C-reactive protein-to-albumin ratio to predict severity of acute pancreatitis and 28-day mortality
- 1Department of Gastroenterology, Chongqing Jiangjin District Hospital of Chinese Medicine, Chongqing, China
- 2Department of Gastroenterology, Jiangjin Hospital, Chongqing University of Chinese Medicine, Chongqing, China
Abstract
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.
Related
- Associations between C-reactive protein-triglyceride glucose index and asthma risk among Chinese adults: evidence from the CHARLS cohort and external hospital-based validation
- Correlation of red cell distribution width-to-albumin ratio combined with SOFA score with 28-day all-cause mortality in patients with acute pancreatitis: A retrospective study based on the MIMIC-IV database
- Serum Calprotectin as predictor of Rheumatoid Arthritis disease severity and Mortality
- Serum SPP1 levels are associated with disease severity and 1-year mortality in primary Sjögren’s syndrome-associated interstitial lung disease
- Hexose-6-phosphate dehydrogenase deficiency disrupts hepatic fatty acid homeostasis and induces triglyceride accumulation
BibTeX
@article{tian2026ability,
title = {{Ability of the triglyceride–glucose index and C-reactive protein-to-albumin ratio to predict severity of acute pancreatitis and 28-day mortality}},
author = {Qiuhui Tian and Yinyin Zhang and Xiaolin Zhu and Ting Luo and Qiumei Cao and Yu Liu},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0359089},
url = {https://doi.org/10.1371/journal.pone.0359089},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Ability of the triglyceride–glucose index and C-reactive protein-to-albumin ratio to predict severity of acute pancreatitis and 28-day mortality
AU - Qiuhui Tian
AU - Yinyin Zhang
AU - Xiaolin Zhu
AU - Ting Luo
AU - Qiumei Cao
AU - Yu Liu
PY - 2026
DA - 2026/09/28
JO - PLOS One
DO - 10.1371/journal.pone.0359089
UR - https://doi.org/10.1371/journal.pone.0359089
AB - 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.
SN - 1932-6203
ER -