Miyokarditli hastalarda hastalık şiddetini, YBÜ'ye yatışı ve toplam hastanede kalış süresini tahmin etmede trigliserit-glikoz indeksinin (TyG indeksi) rolü

Year 2025, Volume: 16 Issue: 1, 57 - 67, 25.03.2025

Hatice Eyiol , Azmi Eyiol , Ahmet Taha Şahin

https://doi.org/10.18663/tjcl.1614758

Abstract

Amaç: Myokardit, enfeksiyöz ve otoimmün nedenler dahil olmak üzere çeşitli etiyolojilere sahip miyokardiyal inflamasyon ile karakterizedir ve geniş bir klinik şiddet aralığında seyredebilir. Prognostik belirteçlerin belirlenmesi, tedavinin bireyselleştirilmesi ve klinik sonuçların iyileştirilmesi açısından önemlidir. Bu çalışmada, Trigliserid-Glukoz (TyG) İndeksi’nin akut myokarditli hastalarda hastalık şiddeti, yoğun bakım ihtiyacı ve hastanede yatış süresi ile ilişkisini değerlendirmek amaçlanmıştır.
Gereç ve Yöntemler: Bu retrospektif çalışmada, Ocak 2015 - Aralık 2023 tarihleri arasında akut myokardit tanısı alan 326 hasta analiz edilmiştir. Demografik veriler, hastalık şiddeti belirteçleri ve TyG İndeksi değerleri dahil olmak üzere klinik ve laboratuvar verileri toplanmıştır. İstatistiksel analizlerle TyG İndeksi’nin yoğun bakım yatışı ve toplam hastanede kalış süresi gibi klinik sonuçlarla ilişkisi değerlendirilmiştir.
Bulgular: Yüksek TyG İndeksi değerine sahip hastalarda yoğun bakım yatış oranları belirgin şekilde artmış, hastanede kalış süresi uzamış ve CRP, ferritin gibi inflamatuar belirteçler daha yüksek bulunmuştur. Ayrıca, TyG İndeksi miyokard hasarı belirteçleri olan troponin ve D-dimer seviyeleri ile de korelasyon göstermiştir. Hipertansiyon, diyabet ve hiperlipidemi gibi ek hastalıkları olan bireylerde TyG İndeksi daha yüksek bulunmuştur.
Sonuç: TyG İndeksi, myokardit şiddetini değerlendirmede ve klinik sonuçları öngörmede değerli bir biyobelirteç olabilir. Kolay erişilebilirliği sayesinde, klinik pratiğe yönelik risk sınıflandırmasında pratik bir araç olarak kullanılabilir. Bulguların doğrulanması ve myokardit patofizyolojisindeki rolünün daha iyi anlaşılması için ileriye dönük çalışmalar gereklidir.

Keywords

Myokardit, TyG İndeksi, Yoğun bakım yatışı, Hastalık şiddeti

The role of the triglyceride-glucose index (TyG Index) in predicting disease severity, ICU admission, and total hospital stay in patients with myocarditis

Abstract

Aim: Myocarditis is characterized by myocardial inflammation, with varying etiologies, including infectious and autoimmune causes, and presents with a broad range of clinical severity. Identifying prognostic markers is essential to tailor treatment and optimize outcomes. This study aims to evaluate the Triglyceride-Glucose (TyG) Index as a potential marker for disease severity, ICU admission, and hospital length of stay in patients with acute myocarditis.
Material and Methods: In this retrospective study, 326 patients diagnosed with acute myocarditis between January 2015 and December 2023 were analyzed. Clinical and laboratory data, including demographics, disease severity markers, and TyG Index values, were collected. Statistical analyses evaluated associations between TyG Index and key clinical outcomes, such as ICU admission and total hospital stay.
Results: Patients with higher TyG Index values had significantly increased ICU admission rates, prolonged hospital stays, and higher levels of inflammatory markers, including CRP and ferritin. The TyG Index also correlated with markers of myocardial injury, such as elevated troponin and D-dimer levels, and was notably higher in patients with comorbidities like hypertension, diabetes, and hyperlipidemia.
Conclusion: The TyG Index appears to be a valuable biomarker for assessing myocarditis severity and predicting clinical outcomes. Given its accessibility, the TyG Index could be a practical tool for risk stratification in clinical settings. Prospective studies are needed to confirm these findings and further clarify its role in the pathophysiology of myocarditis.

Keywords

Myocarditis, TyG Index, ICU admission, Disease severity

References

• Ammirati, E., & Moslehi, J. J. (2023). Diagnosis and treatment of acute myocarditis: a review. Jama, 329(13), 1098-1113.
• Lampejo, T., Durkin, S. M., Bhatt, N., & Guttmann, O. (2021). Acute myocarditis: aetiology, diagnosis and management. Clinical Medicine, 21(5), e505-e510.
• Golpour, A., Patriki, D., Hanson, P. J., McManus, B., & Heidecker, B. (2021). Epidemiological impact of myocarditis. Journal of clinical medicine, 10(4), 603.
• Eyiol A, Eyiol H, Sahin AT. Evaluation of HRR (Hemoglobin/Red Blood Cell Distribution Width Ratio) and RAR (Red Blood Cell Distribution Width/Albumin Ratio) in Myocarditis Patients: Associations with Various Clinical Parameters. International Journal of General Medicine 2024, 17:5085-5093.
• Rroku, A., Kottwitz, J., & Heidecker, B. (2021). Update on myocarditis–what we know so far and where we may be heading. European Heart Journal Acute Cardiovascular Care, 10(4), 455-467.
• Brociek, E., Tymińska, A., Giordani, A. S., Caforio, A. L. P., Wojnicz, R., Grabowski, M., & Ozierański, K. (2023). Myocarditis: etiology, pathogenesis, and their implications in clinical practice. Biology, 12(6), 874.
• Kyaw, T., Drummond, G., Bobik, A., & Peter, K. (2023). Myocarditis: causes, mechanisms, and evolving therapies. Expert Opinion on Therapeutic Targets, 27(3), 225-238.
• Ediger, D. S., Brady, W. J., Koyfman, A., & Long, B. (2024). High risk and low prevalence diseases: Myocarditis. The American Journal of Emergency Medicine.
• Basso C. Myocarditis. New England Journal of Medicine (2022);387(16), 1488-1500.
• Tschöpe C, Ammirati E, Bozkurt B, Caforio A L, Cooper LT, Felix SB, Hare JM, Heidecker B, Heymans S, Hübner N, Kelle S, Klingel K, Maatz H, Parwani AS, Spillmann F, Starling RC, Tsutsui H, Seferovic P, Van Linthout S. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nature Reviews Cardiology (2021);18(3), 169-193.
• Kim HW, Jenista ER, Wendell DC, Azevedo CF, Campbell MJ, Darty SN, Parker MA, Kim RJ. Patients with acute myocarditis following mRNA COVID-19 vaccination. JAMA cardiology (2021); 6(10), 1196-1201.
• Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV & Robicsek A. Myocarditis and pericarditis after vaccination for COVID-19. Jama (2021); 326(12), 1210-1212.
• Alizargar, Javad, et al. "Use of the triglyceride-glucose index (TyG) in cardiovascular disease patients." Cardiovascular diabetology 19.1 (2020): 8
• Tao, Li-Chan, et al. "Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations." Cardiovascular Diabetology 21.1 (2022): 68.
• Heymans, S., Van Linthout, S., Kraus, S. M., Cooper, L. T., & Ntusi, N. A. (2024). Clinical Characteristics and Mechanisms of Acute Myocarditis. Circulation research, 135(2), 397-411.
• Kociol RD, Cooper LT, Fang JC, Moslehi JJ, Pang PS, Sabe MA, Shah RV, Sims DB, Thiene G, Vardeny O. Recognition and initial management of fulminant myocarditis: a scientific statement from the American heart association. Circulation 2020; 141(6):e69-e92.
• McCarthy RE 3rd, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM, Baughman KL. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 2000; 342(10):690–5.
• Ammirati E, Cipriani M, Lilliu M, Sormani P, Varrenti M, Raineri C, Petrella D, Garascia A, Pedrotti P, Roghi A, Bonacina E, Moreo A, Bottiroli M, Gagliardone MP, Mondino M, Ghio S, Totaro R, Turazza FM, Russo CF, Oliva F, Camici PG, Frigerio M. Survival and left ventricular function changes in fulminant versus nonfulminant acute myocarditis. Circulation 2017; 136(6):529–45.
• Ammirati E, Veronese G, Brambatti M, Merlo M, Cipriani M, Potena L, Sormani P, Aoki T, Sugimura K, Sawamura A, Okumura T, Pinney S, Hong K, Shah P, Braun Ö, Van de Heyning CM, Montero S, Petrella D, Huang F, Shimidt F, Raineri C, Lala A, Varrenti M, Foa A, Leone O, Gentile P, Artico J, Agostini P, Patel R, Garascia A, Van Craenenbroeck EM, Hirose K, Isotani A, Murohara T, Arita Y, Sionis A, Fabris E, Hashem S, Garcia-Hernando V, Oliva F, Greenberg B, Shimokawa H, Sinagra G, Adler ED, Frigerio M, Camici PG. Fulminant versus acute nonfulminant myocarditis in patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2019; 74(3):299–311.
• Cooper LT Jr, Hare JM, Tazelaar HD, Edwards WD, Starling RC, Deng MC, Menon S, Mullen GM, Jaski B, Bailey KR, Cunningham MW, Dec GW. Usefulness of immunosuppression for giant cell myocarditis. Am J Cardiol 2008; 102(11):1535–9.
• Kandolin R, Lehtonen J, Salmenkivi K, Raisanen-Sokolowski A, Lommi J, Kupari M. Diagnosis, treatment, and outcome of giant-cell myocarditis in the era of combined immunosuppression. Circ Heart Fail 2013; 6(1):15–22.
• Mahfoud F, Gärtner B, Kindermann M, Ukena C, Gadomski K, Klingel K, Kandolf R, Böhm M, Kindermann I. Virus serology in patients with suspected myocarditis: utility or futility? Eur. Heart J. (2011); 32, 897–903.
• Merlo M, Ammirati E, Gentile P, Artico J, Cannatà A, Finocchiaro G, Barbati G, Sormani P, Varrenti M, Perkan A, Fabris E, Aleksova A, Bussani R, Petrella D, Cipriani M, Rainer C, Frigerio M, Sinagra G. Persistent left ventricular dysfunction after acute lymphocytic myocarditis: frequency and predictors. PLoS ONE (2019); 14, e0214616–e0214628.
• Awadalla M, Mahmood SS, Groarke JD, Hassan MZO, Nohria A, Rokicki A, Murphy SP, Mercaldo ND, Zhang L, Zlotoff DA, Reynolds KL, Alvi RM, Banerji D, Liu S, Heinzerling LM, Jones-O'Connor M, Bakar RB, Cohen JV, Kirchberger MC, Sullivan RJ, Gupta D, Mulligan CP, Shah SP, Ganatra S, Rizvi MA, Sahni G, Tocchetti CG, Lawrence DP, Mahmoudi M, Devereux RB, Forrestal BJ, Mandawat A, Lyon AR, Chen CL, Barac A, Hung J, Thavendiranathan P, Picard MH, Thuny F, Ederhy S, Fradley MG, Neilan TG. Global longitudinal strain and cardiac events in patients with immune checkpoint inhibitor-related myocarditis. J. Am. Coll. Cardiol. (2020); 75, 467–478.
• Barzegar N, Tohidi M, Hasheminia M, Azizi F, Hadaegh F. The impact of triglyceride-glucose index on incident cardiovascular events during 16 years of follow-up: tehran lipid and glucose study. Cardiovasc Diabetol. 2020;19(1):155.
• Tian X, Zuo Y, Chen S, Liu Q, Tao B, Wu S, Wang A. Triglyceride-glucose index is associated with the risk of myocardial infarction: an 11-year prospective study in the Kailuan cohort. Cardiovasc Diabetol. 2021;20(1):19.
• Park B, Lee YJ, Lee HS, Jung DH. The triglyceride-glucose index predicts ischemic heart disease risk in Koreans: a prospective study using national health insurance service data. Cardiovasc Diabetol. 2020;19(1):210
• Gao JW, Hao QY, Gao M, Zhang K, Li XZ, Wang JF, Vuitton DA, Zhang SL, Liu PM. Triglyceride-glucose index in the development of peripheral artery disease: fndings from the atherosclerosis risk in communities (ARIC) study. Cardiovasc Diabetol. 2021;20(1):126
• Gao JW, Hao QY, Gao M, Zhang K, Li XZ, Wang JF, Vuitton DA, Zhang SL, Liu PM. Triglyceride-glucose index in the development of peripheral artery disease: fndings from the atherosclerosis risk in communities (ARIC) study. Cardiovasc Diabetol. 2021;20(1):126
• Li H, Zuo Y, Qian F, Chen S, Tian X, Wang P, Li X, Guo X, Wu S, Wang A. Triglyceride-glucose index variability and incident cardiovascular disease: a prospective cohort study. Cardiovasc Diabetol. 2022;21(1):105.
• Xu X, Huang R, Lin Y, Guo Y, Xiong Z, Zhong X, Ye X, Li M, Zhuang X, Liao X. High triglyceride-glucose index in young adulthood is associated with incident cardiovascular disease and mortality in later life: insight from the CARDIA study. Cardiovasc Diabetol. 2022;21(1):155.
• Huang Z, Ding X, Yue Q, Wang X, Chen Z, Cai Z, Li W, Cai Z, Chen G, Lan Y, et al. Triglyceride-glucose index trajectory and stroke incidence in patients with hypertension: a prospective cohort study. Cardiovasc Diabetol. 2022;21(1):141.