Are lipid ratios and triglyceride-glucose index associated with critical care outcomes in COVID-19 patients?

Abstract

Lipid ratios and the triglyceride and glucose index (TyG) could be a simple biochemical marker of insulin resistance (IR). The current study was carried out to examine the correlation between triglyceride to high-density lipoprotein-cholesterol (TG/HDL-C), total cholesterol to HDL-C (TC/HDL-C), low-density lipoprotein-cholesterol to HDL-C ratio (LDL-C/HDL-C), as well as TyG index with the severity and mortality of severe coronavirus disease 2019 (COVID-19). A total of 1228 confirmed COVID-19 patients were included in the current research. Regression models were performed to evaluate the correlation between the lipid index and severity and mortality of COVID-19. The TyG index and TG/HDL-C levels were significantly higher in the severe patients (P<0.05). TG/HDL-C, LDL-C/HDL-C, TC/HDL-C ratios, and TyG index were significantly lower in survivor cases (P<0.05). Multivariate logistic regression analysis demonstrated that predictors of the severity adjusted for age, sex and BMI were TyG index, TG/HDL-C ratio (OR = 1.42 CI:1.10–1.82, OR = 1.06 CI: 1.02–1.11, respectively). This analysis showed that TG/HDL-C, TC/HDL-C, LDL-C/HDL-C ratios, and TyG index statistically are correlated with COVID-19 mortality (OR = 1.12 CI:1.06–1.18, OR = 1.24 CI:1.05–1.48, OR = 1.47 CI:1.19–1.80, OR = 1.52 CI:1.01–2.31, respectively). In summary, the TyG index and lipid ratios such as TC/HDL-C, TG/HDL-C, LDL-C/HDL-C could be used as an early indicator of COVID-19 mortality. Furthermore, the study revealed that TyG index and TG/HDL-C indices are biochemical markers of COVID-19 severe prognosis.

Connections between Diabetes Mellitus and Metabolic Syndrome and the Outcome of Cardiac Dysfunctions Diagnosed during the Recovery from COVID-19 in Patients without a Previous History of Cardiovascular Diseases

“…The study of Chang et al demonstrated a significant association between the TyG index, as determined before COVID-19, and an elevated risk for severe complications during the acute infection [ 39 ]. In the same vein, some indexes such as the LAP and VAI—characterizing the abdominal obesity phenotype, which is associated with an impaired risk profile—were considered indicators for a worse COVID-19 outcome [ 33 , 40 , 41 ]. Starting from these observations, in our study, by analyzing the relationship between these indexes and the TTE parameters characterizing LVF, RVD, and DD, we evidenced statistically significant correlations ( p < 0.0001) for all of them, but especially for the TyG index, the number of elements defining MS, the level of inflammation (as expressed by the initial CRP values), and the post-acute COVID-19 condition gravity (as quantified by the PCFS scale).…”

“…First, we evaluated the gravity and consequences of the infection from medical records containing results of the chest radiography or CT describing the extent of the lung injury, an ECG, and blood tests. Subsequently, we focused on the analysis of the pre-COVID-19 health status and several clinical and laboratory parameters of interest for this study, such as the presence of chronic diseases (those with current therapies for systemic hypertension or T2DM were excluded from our study [ 36 , 37 , 38 , 39 , 40 , 41 ], but occasionally elevated or borderline values of blood pressure or BBG were accepted), mentions regarding body weight and height, health risk, blood pressure values, and ECG and TTE results (even if considered as normal). Subsequently, all patients had an ECG and TTE to identify any significant cardiovascular alterations that could have been missed in the previous evaluations.…”

Glycemic Dysregulation, Inflammation and Disease Outcomes in Patients Hospitalized with COVID-19: Beyond Diabetes and Obesity

“…Notably, our study found that glycemic dysregulation either upon admission or during hospitalization, as well as elevated levels of TRG/HDL-C ratio and TyG index, were linked with prolonged hospital stay in the patient cohort. The latter ratios have been adopted by researchers as indices of insulin resistance resulting in imbalances of glucose metabolism [ 41 , 42 , 43 ]. Also, TyG index and TRG/HDL-C have been proposed as predictors of glycemic control in normoweight, overweight and obese patients with DM [ 44 ].…”

“…Investigators also found that the TyG index and TRG/HDL-C ratio were significant predictors of severity (OR = 1.42 and OR = 1.06, respectively). Similarly, these indices were associated with COVID-19 mortality (TRG/HDL-C ratio: OR = 1.12, TyG index: OR = 1.52, respectively) [ 43 ].…”

Association between lipid profile and clinical outcomes in COVID-19 patients

“…Furthermore, the exploration of HDL-c levels in pediatric COVID-19 patients by Mietus-Snyder et al 28 , and its significant reduction in severe cases as reported by Agouridis et al 29 and Erman et al 30 , extends the relevance of HDL-c as a prognostic factor across age groups. The examination of lipid ratios, such as those undertaken by Rohani-Rasaf et al 31 and Alcántara-Alonso et al 32 , further elucidates the role of lipid profiles in predicting COVID-19 outcomes, with Zhang et al 24 emphasizing the TG/HDL-c ratio as a marker of cardiovascular risk and poor prognosis in COVID-19 patients. Regarding this, the body of evidence consistently supports the association between low HDL-c levels and adverse COVID-19 outcomes, underscoring the importance of lipid profiles in the disease's risk stratification and management strategies.…”