High TG/HDL Ratio Predicts 28-Day Mortality in Sepsis Patients, Study Shows
China: A recent retrospective study has highlighted the triglyceride-to-high-density lipoprotein (TG/HDL) ratio as a potent predictor of 28-day mortality in patients with sepsis.
Published in Respiratory Medicine, the research was led by Dr. Xiaorong Dong from the Department of Critical Care Medicine, Lanzhou University Second Hospital, China, and colleagues, providing clinicians with a rapid, bedside tool for prognostic assessment in critically ill patients.
The study included 578 patients who met the Sepsis 3.0 criteria. Researchers collected detailed demographic, clinical, and laboratory data, including vital signs, comorbidities, treatment interventions, and outcomes. The TG/HDL ratio was measured within the first 24 hours of ICU admission, and patients were stratified into quartiles (Q1–Q4) to analyze associations with 28-day survival.
The study led to the following notable findings:
- Patients in the highest TG/HDL quartile (Q4) had a significantly increased 28-day mortality risk, with odds ratios ranging from 2.69 to 4.66 compared to the lowest quartile (Q1).
- Patients in the middle quartiles (Q2 and Q3) did not exhibit a significant increase in mortality risk.
- Kaplan-Meier survival curves showed that Q4 patients had substantially lower survival rates.
- Nonlinear regression analyses confirmed a U-shaped relationship between TG/HDL ratio and 28-day mortality.
- The elevated mortality risk associated with high TG/HDL was particularly pronounced in male and younger patients.
- Individuals with coagulation abnormalities also experienced a higher mortality risk linked to a high TG/HDL ratio.
- The TG/HDL ratio reflects both lipid metabolism and inflammatory-dyslipidemic imbalance contributing to sepsis progression and mortality.
According to the study, the TG/HDL ratio offers practical advantages for clinical use. It can be measured rapidly upon ICU admission, facilitating early risk stratification and aiding decision-making regarding the intensity of monitoring and interventions. Given its nonlinear characteristics and subgroup-specific relevance, TG/HDL can help identify patients at the highest short-term risk who may benefit from more aggressive management.
The authors emphasized that integrating TG/HDL into clinical practice could enhance prognostic precision in sepsis, complementing existing scoring systems such as SOFA and APACHE II. They noted that while the findings are promising, the study’s retrospective design calls for prospective validation in larger, diverse populations to confirm the robustness and generalizability of TG/HDL as a mortality predictor.
The research emphasizes the value of the TG/HDL ratio as an independent predictor of 28-day mortality in sepsis. Its rapid assessment, clear stratification of high-risk subgroups, and reflection of underlying inflammatory and metabolic disturbances provide critical insights for clinicians managing critically ill patients. The study highlights the potential of this simple biomarker to guide early clinical decisions and improve patient outcomes in sepsis.
Reference:
Dong, X., Zhang, B., Ma, L., Liu, X., Zheng, X., & Ma, X. (2025). Triglyceride-to-high-density lipoprotein ratio as a predictor of 28-day mortality risk in patients with Sepsis: A retrospective cohort study. Respiratory Medicine, 248, 108419. https://doi.org/10.1016/j.rmed.2025.108419
Next Story