The Triglyceride-Glucose Index in Hepatolithiasis: Association with Metabolic Dysfunction and Sex-Specific Differences in Clinical Outcomes

Objectives: Although insulin resistance (IR) is a well-established risk factor of gallstones, its specific association with hepatolithiasis remains unclear.This study aimed to evaluate the triglyceride-glucose (TyG) index, a surrogate marker for IR, in patients with hepatolithiasis and to examine sex-specific differences in metabolic profiles and clinical outcomes.Methods: This single-center, retrospective case-control study included 81 patients with hepatolithiasis and 44 living liver donors as controls.Due to missing triglyceride data, the TyG index was calculated in a subset of participants (21 patients and 35 controls).The metabolic profiles, including the TyG index, were compared between the groups, and sex-specific differences in postoperative outcomes were analyzed.Findings: The crude TyG index was significantly higher in hepatolithiasis patients than controls (8.8±0.7 vs. 8.3±0.6,p=0.006); however, this significance disappeared after adjusting for age and sex (p=0.834).Among the patient group, no significant difference in the TyG index was identified between males and females (8.92 vs. 8.76, p=0.606).However, female patients had significantly longer postoperative hospital stays (14.0±9.7 days vs. 8.8±6.2 days, p<0.001).This association remained significant in multivariate analysis after adjusting for surgical type (p=0.008).Conclusions: The elevated TyG index in hepatolithiasis is heavily confounded by age, highlighting the need for age-matched studies to confirm its independent metabolic role.Although the metabolic burden appears comparable between sexes, the prolonged recovery in female patients highlights a need for tailored management, warranting further validation of unmeasured clinical confounders.