Insulin resistance-related surrogate indices and recurrence of mild hypertriglyceridemic acute pancreatitis: a retrospective cohort study

Background Surrogate indices related to insulin resistance (IR) may reflect the metabolic abnormalities associated with hypertriglyceridemic acute pancreatitis (HAP). However, their association with disease recurrence remains unclear. Methods A total of 412 eligible patients with HAP were included. Insulin resistance (IR) was assessed using the triglyceride-glucose index (TyG index), triglyceride-glucose-body mass index (TyG-BMI), metabolic score for insulin resistance (METS-IR), and triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C). Associations with HAP recurrence were examined using multivariable logistic regression and restricted cubic spline (RCS) analyses. Predictive and reclassification performances were evaluated using receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and false discovery rate (FDR) correction. Results The cumulative recurrence rate of HAP was 41.26%. Following comprehensive covariate adjustment, individuals in the highest quartiles of TyG-BMI (OR = 2.70, 95% CI: 1.42–5.20), METS-IR (OR = 2.62, 95% CI: 1.37–5.06), and TG/HDL-C (OR = 2.21, 95% CI: 1.17–4.22) exhibited a significantly elevated risk of recurrence. These principal associations remained robust after FDR correction. Additionally, RCS modeling confirmed significant dose-response trajectories for the TyG index, TyG-BMI, and METS-IR. Among the evaluated indices, TyG-BMI yielded the numerically highest AUC (0.613). Moreover, discordant outcomes in NRI and IDI analyses relative to alternative indices suggested that no single marker holds absolute predictive superiority. Conclusion Baseline insulin resistance-related surrogate indices are independently associated with the recurrence of mild HAP. These routine and accessible parameters may serve as practical prognostic indicators for long-term recurrence risk.