Role of the triglyceride glucose (TyG) index in stable chronic obstructive pulmonary disease and acute exacerbations of COPD

Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) accelerate disease progression and mortality, yet accessible biomarkers for risk stratification remain limited. The triglyceride-glucose (TyG) index may reflect the metabolic-inflammatory axis implicated in exacerbation susceptibility. Methods In this analytical cross-sectional study, 91 patients with COPD (48 stable, 43 AECOPD per GOLD 2025/Rome criteria) were consecutively recruited. The TyG index calculation was performed as TyG index = Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL) / 2]. Multivariable logistic regression adjusted for age, diabetes mellitus, hypertension, smoking index, BMI and C-reactive protein (CRP); diagnostic performance was assessed by ROC analysis. Results The TyG index was significantly elevated in AECOPD versus stable disease (4.7 ± 0.2 vs. 4.6 ± 0.2; p < 0.001) and associated with AECOPD (OR = 29.06, 95% CI: 1.51–558.31, p = 0.025). It correlated positively with CRP ( r = 0.329; p < 0.001) and inversely with forced expiratory volume in one second (FEV₁) ( r = − 0.370; p < 0.001). For severity stratification, a cutoff > 4.6 yielded an AUC of 0.825 (95%CI: 0.688–0.963), sensitivity of 79.3%, specificity of 85.7%, and positive predictive value of 92.0%. Conclusions The TyG index may represent a simple, low-cost, potential adjunctive biomarker, The TyG index is independently associated with AECOPD and exacerbation severity and prospective multicenter validation is required before routine clinical use.