{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:15:25Z","timestamp":1788372925881,"version":"build-2803163510"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Fibrotic lung diseases are associated with significant morbidity and mortality, with a rising prevalence. Prognostic indicators for these diseases include thoracic computed tomography (CT) findings and pulmonary function test (PFT) measures. The triglyceride-glucose (TyG) index, a fasting triglyceride- and glucose-derived surrogate marker of insulin resistance, has been associated with several clinical outcomes; however, its relationship with pulmonary function and all-cause mortality within the non-diabetic range in patients with fibrotic lung disease remains inadequately studied. This study aimed to investigate the association between variability in the TyG index within the non-diabetic range, baseline pulmonary function measures, and all-cause mortality in patients with fibrotic lung disease receiving antifibrotic therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study was conducted on 144 patients with fibrotic lung disease who received antifibrotic therapy between 1 January 2015 and 1 June 2023. Demographic data, comorbidities, smoking status, PFT measures, fasting glucose, triglyceride levels, and survival data were collected. The TyG index was calculated using the formula: Ln [(fasting triglycerides (mg\/dL) \u00d7 fasting glucose (mg\/dL)) \/ 2]. Survival time was calculated from initiation of antifibrotic therapy to death from any cause or last clinical follow-up, with a median follow-up duration of 33.8 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age of the cohort was 67.4 years, and 31.9% of the patients were female. The mean TyG index was 8.78. During follow-up, 54 of 144 patients (37.5%) died. In the multivariable Cox regression analysis, the TyG index was not significantly associated with all-cause mortality (adjusted HR\u2009=\u20090.80, 95% CI: 0.40\u20131.60, p\u2009=\u20090.54). Lower FVC% and greater cumulative smoking exposure were associated with all-cause mortality in the adjusted model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this selected cohort of non-diabetic patients with fibrotic lung disease receiving antifibrotic therapy, the TyG index was not significantly associated with all-cause mortality. No consistent association with baseline pulmonary function measures was observed, apart from a weak exploratory inverse correlation with DLCO. However, the restricted metabolic variability and limited statistical precision of the cohort may have reduced the ability to detect modest but potentially clinically meaningful associations. Further prospective studies are needed to clarify the potential prognostic relevance of the TyG index in broader fibrotic lung disease populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0357706","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:34:59Z","timestamp":1788370499000},"page":"e0357706","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between triglyceride-glucose index and all-cause mortality in non-diabetic patients with fibrotic lung disease receiving antifibrotic therapy: A retrospective cohort study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8822-7944","authenticated-orcid":true,"given":"Aysegul","family":"Erinc","sequence":"first","affiliation":[{"name":"Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Health Sciences University","place":["Istanbul, Turkey"],"department":["Department of Pulmonology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Kirac","sequence":"additional","affiliation":[{"name":"Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Health Sciences University","place":["Istanbul, Turkey"],"department":["Department of Pulmonology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma Ezgi","family":"Altun Acar","sequence":"additional","affiliation":[{"name":"Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Health Sciences University","place":["Istanbul, Turkey"],"department":["Department of Pulmonology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Cagri","family":"Onal","sequence":"additional","affiliation":[{"name":"Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Health Sciences University","place":["Istanbul, Turkey"],"department":["Department of Pulmonology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erdogan","family":"Cetinkaya","sequence":"additional","affiliation":[{"name":"Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Health Sciences University","place":["Istanbul, Turkey"],"department":["Department of Pulmonology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"issue":"9","key":"pone.0357706.ref001","doi-asserted-by":"crossref","DOI":"10.1164\/rccm.202202-0399ST","article-title":"Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS\/ERS\/JRS\/ALAT clinical practice guideline","volume":"205","author":"G Raghu","year":"2022","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0357706.ref002","doi-asserted-by":"crossref","first-page":"196","DOI":"10.3389\/fpubh.2020.00196","article-title":"Diabetes mellitus contributes to idiopathic pulmonary fibrosis: a review from clinical appearance to possible pathogenesis","volume":"8","author":"D Wang","year":"2020","journal-title":"Front Public Health"},{"issue":"3","key":"pone.0357706.ref003","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/j.chest.2021.03.056","article-title":"Association of Triglyceride-Glucose Index and Lung Health: A Population-Based Study","volume":"160","author":"TD Wu","year":"2021","journal-title":"Chest"},{"issue":"4","key":"pone.0357706.ref004","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1089\/met.2008.0034","article-title":"The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects","volume":"6","author":"LE Simental-Mend\u00eda","year":"2008","journal-title":"Metab Syndr Relat Disord"},{"issue":"1","key":"pone.0357706.ref005","first-page":"44","article-title":"Triglyceride-glucose index as a biomarker of insulin resistance, diabetes mellitus, metabolic syndrome, and cardiovascular disease: A review","volume":"35","author":"LB Kurniawan","year":"2024","journal-title":"EJIFCC"},{"key":"pone.0357706.ref006","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ypmed.2016.01.022","article-title":"Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort","volume":"86","author":"D Navarro-Gonz\u00e1lez","year":"2016","journal-title":"Prev Med"},{"issue":"7","key":"pone.0357706.ref007","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/ijcp.12124","article-title":"Markers of insulin resistance and carotid atherosclerosis. A comparison of the homeostasis model assessment and triglyceride glucose index","volume":"67","author":"C Irace","year":"2013","journal-title":"Int J Clin Pract"},{"issue":"1","key":"pone.0357706.ref008","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12933-017-0514-x","article-title":"Cumulative increased risk of incident type 2 diabetes mellitus with increasing triglyceride glucose index in normal-weight people: The Rural Chinese Cohort Study","volume":"16","author":"M Zhang","year":"2017","journal-title":"Cardiovasc Diabetol"},{"issue":"10","key":"pone.0357706.ref009","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.3346\/jkms.2010.25.10.1480","article-title":"Metabolic syndrome, insulin resistance and systemic inflammation as risk factors for reduced lung function in Korean nonsmoking males","volume":"25","author":"SY Lim","year":"2010","journal-title":"J Korean Med Sci"},{"issue":"3","key":"pone.0357706.ref010","doi-asserted-by":"crossref","first-page":"285","DOI":"10.12998\/wjcc.v3.i3.285","article-title":"Asthma and metabolic syndrome: Current knowledge and future perspectives","volume":"3","author":"L Serafino-Agrusa","year":"2015","journal-title":"World J Clin Cases"},{"issue":"5","key":"pone.0357706.ref011","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/j.1365-2222.2008.03197.x","article-title":"Insulin resistance as a predictor of incident asthma-like symptoms in adults","volume":"39","author":"BH Thuesen","year":"2009","journal-title":"Clin Exp Allergy"},{"issue":"1","key":"pone.0357706.ref012","doi-asserted-by":"crossref","first-page":"55","DOI":"10.2337\/dc09-0880","article-title":"Patients diagnosed with diabetes are at increased risk for asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and pneumonia but not lung cancer","volume":"33","author":"SF Ehrlich","year":"2010","journal-title":"Diabetes Care"},{"issue":"6","key":"pone.0357706.ref013","article-title":"Prevalence of metabolic syndrome in COPD patients and its consequences","volume":"9","author":"M-K Breyer","year":"2014","journal-title":"PLoS One"},{"issue":"3","key":"pone.0357706.ref014","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1165\/rcmb.2020-0335OC","article-title":"Dietary Carbohydrates and Fat Induce Distinct Surfactant Alterations in Mice","volume":"64","author":"J Schipke","year":"2021","journal-title":"Am J Respir Cell Mol Biol"},{"key":"pone.0357706.ref015","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1146\/annurev-pathol-012513-104706","article-title":"Pathogenesis of idiopathic pulmonary fibrosis","volume":"9","author":"PJ Wolters","year":"2014","journal-title":"Annu Rev Pathol"},{"issue":"1","key":"pone.0357706.ref016","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1186\/s12890-023-02746-4","article-title":"Assessing, updating and utilising primary care smoking records for lung cancer screening","volume":"23","author":"G McCutchan","year":"2023","journal-title":"BMC Pulm Med"},{"key":"pone.0357706.ref017","doi-asserted-by":"crossref","DOI":"10.4414\/smw.2015.14139","article-title":"Idiopathic pulmonary fibrosis: the turning point is now!","volume":"145","author":"M Funke","year":"2015","journal-title":"Swiss Med Wkly"},{"issue":"2","key":"pone.0357706.ref018","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s00281-017-0666-5","article-title":"Hemostasis, endothelial stress, inflammation, and the metabolic syndrome","volume":"40","author":"G Grandl","year":"2018","journal-title":"Semin Immunopathol"},{"issue":"3","key":"pone.0357706.ref019","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s11739-011-0591-x","article-title":"Weight loss is associated with improved endothelial dysfunction via NOX2-generated oxidative stress down-regulation in patients with the metabolic syndrome","volume":"7","author":"F Angelico","year":"2012","journal-title":"Intern Emerg Med"},{"issue":"9","key":"pone.0357706.ref020","doi-asserted-by":"crossref","first-page":"2785","DOI":"10.3390\/nu12092785","article-title":"Nutrition, Bioenergetics, and Metabolic Syndrome","volume":"12","author":"FJ Garc\u00eda-Garc\u00eda","year":"2020","journal-title":"Nutrients"},{"key":"pone.0357706.ref021","doi-asserted-by":"crossref","DOI":"10.1016\/j.amjcard.2005.06.006","article-title":"Recent National Cholesterol Education Program Adult Treatment Panel III update: adjustments and options","volume":"96","author":"NJ Stone","year":"2005","journal-title":"Am J Cardiol"},{"issue":"1","key":"pone.0357706.ref022","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ccm.2011.11.002","article-title":"Idiopathic pulmonary fibrosis: pathobiology of novel approaches to treatment","volume":"33","author":"TM Maher","year":"2012","journal-title":"Clin Chest Med"},{"key":"pone.0357706.ref023","doi-asserted-by":"crossref","first-page":"4031","DOI":"10.2147\/DMSO.S487744","article-title":"Association between triglyceride-glucose index and lung function parameters in the general population undergoing health examinations","volume":"17","author":"Y Yang","year":"2024","journal-title":"Diabetes Metab Syndr Obes"},{"issue":"4","key":"pone.0357706.ref024","doi-asserted-by":"crossref","first-page":"4004","DOI":"10.3390\/ijms24044004","article-title":"Fibrosis: types, effects, markers, mechanisms for disease progression, and its relation with oxidative stress, immunity, and inflammation","volume":"24","author":"SA Antar","year":"2023","journal-title":"Int J Mol Sci"},{"key":"pone.0357706.ref025","first-page":"808260","article-title":"Smoking and idiopathic pulmonary fibrosis","volume":"2012","author":"CK Oh","year":"2012","journal-title":"Pulm Med"},{"issue":"3","key":"pone.0357706.ref026","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1186\/1617-9625-1-3-219","article-title":"Oxidative stress, cell death, and other damage to alveolar epithelial cells induced by cigarette smoke","volume":"1","author":"K Aoshiba","year":"2003","journal-title":"Tob Induc Dis"},{"issue":"1","key":"pone.0357706.ref027","doi-asserted-by":"crossref","first-page":"8857","DOI":"10.1038\/s41598-024-59649-5","article-title":"Prognostic implication of 1-year decline in diffusing capacity in newly diagnosed idiopathic pulmonary fibrosis","volume":"14","author":"H Lee","year":"2024","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0357706.ref028","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1159\/000504763","article-title":"Idiopathic Pulmonary Fibrosis: Best Practice in Monitoring and Managing a Relentless Fibrotic Disease","volume":"99","author":"WA Wuyts","year":"2020","journal-title":"Respiration"},{"issue":"3","key":"pone.0357706.ref029","doi-asserted-by":"crossref","first-page":"2103187","DOI":"10.1183\/13993003.03187-2021","article-title":"Progressive pulmonary fibrosis: an expert group consensus statement","volume":"61","author":"SK Rajan","year":"2023","journal-title":"Eur Respir J"},{"key":"pone.0357706.ref030","doi-asserted-by":"crossref","first-page":"17534666241275329","DOI":"10.1177\/17534666241275329","article-title":"Clinical implications of six-minute walk test in patients with idiopathic pulmonary fibrosis: a retrospective cohort study","volume":"18","author":"MJ Kim","year":"2024","journal-title":"Ther Adv Respir Dis"},{"issue":"2","key":"pone.0357706.ref031","doi-asserted-by":"crossref","first-page":"00423","DOI":"10.1183\/23120541.00423-2022","article-title":"Nintedanib for non-IPF progressive pulmonary fibrosis: 12-month outcome data from a real-world multicentre observational study","volume":"9","author":"L Raman","year":"2023","journal-title":"ERJ Open Res"},{"key":"pone.0357706.ref032","doi-asserted-by":"crossref","first-page":"1431405","DOI":"10.3389\/fendo.2024.1431405","article-title":"Evaluating the impact of type 2 diabetes mellitus on pulmonary vascular function and the development of pulmonary fibrosis","volume":"15","author":"N Mzimela","year":"2024","journal-title":"Front Endocrinol (Lausanne)"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0357706","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:35:05Z","timestamp":1788370505000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0357706"}},"subtitle":[],"editor":[{"given":"Amir Hossein","family":"Behnoush","sequence":"first","affiliation":[{"name":"Northwestern University Feinberg School of Medicine","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":32,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0357706","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]}}}