Triglyceride-Glucose Index is an Independent Risk Factor for Hepatocellular Carcinoma Development in Patients with HBV-Related Liver Cirrhosis

Figures & data

Figure 1 Screening of patients with HBV-related LC.

Abbreviations: HBV, hepatitis B virus; LC, liver cirrhosis; HCC, hepatocellular carcinoma.

Table 1 Baseline Characteristics of Patients with HBV-Related LC

	Patients with HCC (N=56)	Patients without HCC (N=186)	Z or χ^2 value	P-value
Age, years	57 (51,64)	51 (45,59)	−3.274	<0.01
Male, n (%)	41 (73.2)	122 (65.6)	1.137	0.29
DC, n (%)	45 (80.4)	100 (53.8)	12.657	<0.01
ALT, U/L	35 (23,53)	33 (21,65)	−0.210	0.83
AST, U/L	43 (32,55)	35 (25,52)	−1.669	0.10
TBil, μmol/L	22.1 (14.9,30.9)	22.1 (14.8,34.3)	−0.058	0.95
CHOL, mmol/L	3.57 (2.94,4.55)	3.71 (3.03,4.20)	−0.668	0.50
TG, mmol/L	0.86 (0.63,1.19)	0.78 (0.59,1.17)	−0.881	0.38
FPG, mmol/L	5.7 (4.8,7.4)	5.4 (4.9,6.5)	−1.092	0.28
TyG	8.32 (8.01,8.79)	8.19 (7.83,8.58)	−1.992	0.05
ALB, g/L	34.4 (30.2,41.8)	38.5 (32.8,42.7)	−1.691	0.09
WBC, ×10^9/L	3.79 (2.75,5.33)	4.19 (3.10,6.00)	−1.400	0.16
PLT, ×10^9/L	70 (52,108)	94 (55,144)	−2.511	0.01
INR	1.21 (1.07,1.36)	1.15 (1.05,1.33)	−0.824	0.41
AFP, ng/mL	6.97 (3.33,27.14)	4.52 (2.29,10.08)	−2.404	0.02
Positive HBV DNA, n (%)	8 (14.3)	5 (2.7)	11.389	<0.01

Note: Data are presented as median (IQR) or number (%).

Abbreviations: HCC, hepatocellular carcinoma; DC, decompensated cirrhosis; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBil, total bilirubin; CHOL, total cholesterol; TG, triglyceride; FPG, fasting plasma glucose; TyG, triglyceride–glucose; ALB, albumin; WBC, white blood cell; PLT, platelet; INR, international normalized ratio; AFP, alpha-fetoprotein.

Table 2 Baseline Characteristics of Patients with HBV-Related DC

	Patients with HCC (N=45)	Patients without HCC (N=100)	Z or χ^2 value	P-value
Age, years	57 (52,65)	55 (45,62)	−2.155	0.03
Male, n (%)	32 (71.1)	62 (62.0)	1.130	0.29
ALT, U/L	30 (24,53)	29 (21,43)	−1.210	0.23
AST, U/L	43 (32,54)	36 (28,52)	−1.394	0.16
TBil, μmol/L	23.6 (15.6,33.5)	29.0 (17.5,41.4)	−1.071	0.28
CHOL, mmol/L	3.39 (2.80,4.54)	3.35 (2.70,4.00)	−1.056	0.29
TG, mmol/L	0.79 (0.60,1.16)	0.70 (0.51,1.02)	−1.738	0.08
FPG, mmol/L	5.9 (4.8,7.6)	5.5 (4.9,7.1)	−0.346	0.73
TyG	8.26 (7.98,8.79)	8.08 (7.75,8.47)	−2.220	0.03
ALB, g/L	31.9 (29.6,40.8)	33.8 (29.5,38.5)	−0.361	0.72
WBC, ×10^9/L	3.46 (2.72,4.85)	3.85 (2.78,5.56)	−0.699	0.49
PLT, ×10^9/L	63 (41,89)	65 (45,113)	−0.782	0.43
INR	1.23 (1.09,1.37)	1.29 (1.13,1.46)	−1.203	0.23
HBeAg, %	25.0	15.7	1.566	0.21
Positive HBV DNA, n (%)	6 (13.3)	4 (4.0)	4.210	0.04

Note: Data are presented as median (IQR) or number (%).

Abbreviations: HCC, hepatocellular carcinoma; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBil, total bilirubin; CHOL, total cholesterol; TG, triglyceride; FPG, fasting plasma glucose; TyG, triglyceride–glucose; ALB, albumin; WBC, white blood cell; PLT, platelet; INR, international normalized ratio; AFP, alpha-fetoprotein.

Table 3 Baseline Characteristics of Patients with HBV-Related CC

	Patients with HCC (N=11)	Patients without HCC (N=86)	Z or χ^2 value	P-value
Age, years	51 (44,61)	50 (43,56)	−0.866	0.39
Male, n (%)	9 (81.8)	60 (69.8)	0.228	0.63
ALT, U/L	48 (22,117)	42 (22,102)	−0.023	0.98
AST, U/L	39 (24,103)	32 (25,54)	−0.649	0.52
TBil, μmol/L	18.8 (13.1,26.7)	19.2 (13.9,23.9)	−0.375	0.71
CHOL, mmol/L	4.28 (3.94,4.71)	3.91 (3.41,4.46)	−1.758	0.08
TG, mmol/L	1.05 (0.83,1.42)	0.97 (0.71,1.35)	−0.950	0.34
FPG, mmol/L	5.7 (4.6,7.4)	5.3 (4.9,5.8)	−0.826	0.41
TyG	8.49 (8.21,8.96)	8.33 (7.93,8.70)	−1.331	0.18
ALB, g/L	43.0 (40.2,46.1)	42.2 (39.1,44.9)	−0.745	0.46
WBC, ×10^9/L	5.47 (3.29,6.15)	4.82 (3.55,6.11)	−0.307	0.76
PLT, ×10^9/L	109 (73,155)	115 (86,157)	−0.518	0.61
INR	1.07 (1.00,1.16)	1.07 (1.00,1.15)	−0.154	0.88
AFP, ng/mL	6.16 (3.40,58.15)	4.81 (2.32,10.09)	−0.762	0.45
Positive HBV DNA, n (%)	2 (18.2)	1 (1.2)		0.03

Note: Data are presented as median (IQR) or number (%).

Abbreviations: HCC, hepatocellular carcinoma; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBil, total bilirubin; CHOL, total cholesterol; TG, triglyceride; FPG, fasting plasma glucose; TyG, triglyceride–glucose; ALB, albumin; WBC, white blood cell; PLT, platelet; INR, international normalized ratio; AFP, alpha-fetoprotein.

Table 4 Risk Factors for HCC Development in Patients with HBV-Related LC

Variables	Univariate analysis			Multivariate analysis
	OR	95% CI	P-value	OR	95% CI	P-value
Age	1.046	1.015–1.078	<0.01	1.043	1.009–1.079	0.01
Male	1.434	0.738–2.786	0.29
DC	3.518	1.713–7.224	<0.01	2.882	1.253–6.353	0.01
ALT	0.999	0.996–1.001	0.33
AST	0.999	0.996–1.002	0.54
TBil	1.001	0.985–1.018	0.88
CHOL	1.132	0.831–1.542	0.43
TyG	1.587	0.954–2.640	0.08	2.602	1.439–4.704	<0.01
ALB	0.959	0.918–1.001	0.05
WBC	0.930	0.806–1.074	0.32
PLT	0.992	0.986–0.998	<0.01	0.994	0.988–1.000	0.05
INR	1.324	0.377–4.652	0.66
AFP	1.001	0.998–1.004	0.70
Positive HBV DNA	6.033	1.888–19.280	<0.01	13.096	3.108–55.180	<0.01

Abbreviations: HCC, hepatocellular carcinoma; DC, decompensated cirrhosis; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBil, total bilirubin; CHOL, total cholesterol; TyG, triglyceride-glucose; ALB, albumin; WBC, white blood cell; PLT, platelet; INR, international normalized ratio; AFP, alpha-fetoprotein.

Figure 2 ROC curve of Model (Age_DC_TyG_PLT_positive HBV DNA).

Table 5 Risk Factors for HCC Development in Patients with HBV-Related DC

Variables	Univariate Analysis			Multivariate Analysis
	OR	95% CI	P-value	OR	95% CI	P-value
Age	1.035	1.000–1.071	<0.05	1.045	1.007–1.085	0.02
Male	1.509	0.705–3.228	0.29
ALT	0.999	0.995–1.002	0.45
AST	0.999	0.995–1.002	0.43
TBil	0.993	0.974–1.011	0.44
CHOL	1.288	0.913–1.817	0.15
TyG	1.907	1.030–3.534	0.04	2.620	1.320–5.200	<0.01
ALB	0.993	0.941–1.048	0.80
WBC	0.951	0.816–1.108	0.52
PLT	0.995	0.989–1.001	0.10
INR	0.345	0.073–1.638	0.18
AFP	1.001	0.997–1.004	0.76
Positive HBV DNA	3.692	0.988–13.805	0.05	6.081	1.438–25.720	0.01

Abbreviations: HCC, hepatocellular carcinoma; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBil, total bilirubin; CHOL, total cholesterol; TyG, triglyceride-glucose; ALB, albumin; WBC, white blood cell; PLT, platelet; INR, international normalized ratio; AFP, alpha-fetoprotein.

Table 6 Risk Factors for HCC Development in Patients with HBV-Related CC

Variables	Univariate Analysis			Multivariate Analysis
	OR	95% CI	P-value	OR	95% CI	P-value
Age	1.033	0.964–1.106	0.36
Male	1.950	0.394–9.656	0.41
ALT	1.000	0.997–1.003	0.89
AST	1.001	0.996–1.007	0.61
TBil	0.977	0.909–1.050	0.53
CHOL	1.835	0.783–4.303	0.16
TyG	1.957	0.682–5.613	0.212
ALB	1.050	0.909–1.214	0.51
WBC	1.035	0.744–1.441	0.84
PLT	0.995	0.983–1.008	0.47
INR	0.975	0.003–279.223	0.99
AFP	1.001	0.994–1.007	0.86
Positive HBV DNA	18.889	1.555–229.388	0.02

Abbreviations: HCC, hepatocellular carcinoma; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBil, total bilirubin; CHOL, total cholesterol; TyG, triglyceride-glucose; ALB, albumin; WBC, white blood cell; PLT, platelet; INR, international normalized ratio; AFP, alpha-fetoprotein.

Figure 3 Incidence of HCC development in patients with LC (A), DC (B), or CC (C).

Abbreviations: LC, liver cirrhosis; CC, compensated cirrhosis; DC, decompensated cirrhosis; HCC, hepatocellular carcinoma.