Role of the triglyceride glucose (TyG) index in stable chronic obstructive pulmonary disease and acute exacerbations of COPD

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) accelerate disease progression and mortality, yet accessible biomarkers for risk stratification remain limited. The triglyceride-glucose (TyG) index may reflect the metabolic-inflammatory axis implicated in exacerbation susceptibility. In this analytical cross-sectional study, 91 patients with COPD (48 stable, 43 AECOPD per GOLD 2025/Rome criteria) were consecutively recruited. The TyG index calculation was performed as TyG index = Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL) / 2]. Multivariable logistic regression adjusted for age, diabetes mellitus, hypertension, smoking index, BMI and C-reactive protein (CRP); diagnostic performance was assessed by ROC analysis. The TyG index was significantly elevated in AECOPD versus stable disease (4.7 ± 0.2 vs. 4.6 ± 0.2; p < 0.001) and associated with AECOPD (OR = 29.06, 95% CI: 1.51–558.31, p = 0.025). It correlated positively with CRP (r = 0.329; p < 0.001) and inversely with forced expiratory volume in one second (FEV₁) (r = − 0.370; p < 0.001). For severity stratification, a cutoff > 4.6 yielded an AUC of 0.825 (95%CI: 0.688–0.963), sensitivity of 79.3%, specificity of 85.7%, and positive predictive value of 92.0%. The TyG index may represent a simple, low-cost, potential adjunctive biomarker, The TyG index is independently associated with AECOPD and exacerbation severity and prospective multicenter validation is required before routine clinical use. Role of the Triglyceride Glucose Index (TyG) in Stable Chronic Obstructive Pulmonary Disease and Acute Exacerbations of COPD. In this cross-sectional study of 91 COPD patients (48 stable, 43 acute exacerbation), the TyG index [ln(fasting triglycerides × fasting glucose/2)] was evaluated as a proposed surrogate of insulin resistance. TyG values were significantly higher in acute exacerbations (4.7±0.2 vs. 4.6±0.2; p<0.001), correlated positively with C-reactive protein (r=0.329) and inversely with FEV₁ (r=−0.370), and independently predicted exacerbation occurrence (adjusted OR 15.636, 95% CI: 1.333–183.456). ROC analysis yielded AUC 0.709 for exacerbation detection (cutoff >4.56) and 0.825 for moderate-to-severe severity stratification (cutoff >4.6; PPV 92.0%). These preliminary findings suggest the TyG index may assist in metabolic risk profiling; prospective validation is required before clinical implementation. Abbreviations: COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; FEV₁, forced expiratory volume in one second; OR, odds ratio; CI, confidence interval; PPV, positive predictive value Role of the Triglyceride Glucose Index (TyG) in Stable Chronic Obstructive Pulmonary Disease and Acute Exacerbations of COPD. In this cross-sectional study of 91 COPD patients (48 stable, 43 acute exacerbation), the TyG index [ln(fasting triglycerides × fasting glucose/2)] was evaluated as a proposed surrogate of insulin resistance. TyG values were significantly higher in acute exacerbations (4.7±0.2 vs. 4.6±0.2; p<0.001), correlated positively with C-reactive protein (r=0.329) and inversely with FEV₁ (r=−0.370), and independently predicted exacerbation occurrence (adjusted OR 15.636, 95% CI: 1.333–183.456). ROC analysis yielded AUC 0.709 for exacerbation detection (cutoff >4.56) and 0.825 for moderate-to-severe severity stratification (cutoff >4.6; PPV 92.0%). These preliminary findings suggest the TyG index may assist in metabolic risk profiling; prospective validation is required before clinical implementation. Abbreviations: COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; FEV₁, forced expiratory volume in one second; OR, odds ratio; CI, confidence interval; PPV, positive predictive value