Synergistic and mediating roles of the triglyceride-glucose index and stress hyperglycemia ratio in predicting in-hospital adverse events in acute aortic syndrome patients: a large retrospective cohort study

Background: This study aimed to evaluate the predictive value of triglyceride-glucose (TyG), stress hyperglycemia ratio (SHR), and their combination for in-hospital aorta-related adverse events (AAEs) in acute aortic syndrome (AAS) patients. Methods: This large, single-center, retrospective cohort study included 2997 consecutive patients with AAS. The composite endpoint was in-hospital AAEs comprising all-cause mortality, aortic dissection rupture, acute myocardial infarction, and acute renal insufficiency. Results: Patients in the highest TyG group (≥ 8.92) and the highest SHR group (≥ 1.17) exhibited significantly increased odds of AAEs compared with those in the lowest respective groups [TyG, odds ratio (OR): 2.001, 95% confidence interval (CI): 1.405–2.851; SHR, OR: 2.439, 95% CI: 1.662–3.578]. Patients with both the highest TyG and SHR demonstrated the highest odds of AAEs (OR: 2.605, 95% CI: 1.825–3.718). Receiver Operating Characteristic (ROC) analysis confirmed that the TyG-SHR combination model offered superior predictive power for AAEs compared with the basic model (AUC: 0.690 vs 0.643, P = 0.002). Mediation analysis revealed that SHR significantly mediated the association between TyG and AAEs (mediation proportion: 34.34%, P < 0.001). Conclusion: The combination of high TyG (≥.92) and elevated SHR (≥1.17) was significantly associated with increased odds of in-hospital AAEs in patients with AAS.