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<p>Urolithiasis has been increasingly recognized as a manifestation of systemic metabolic dysfunction rather than solely a local urinary disorder. In this multicenter cross-sectional study, we evaluated and compared the associations and discriminatory performance of four commonly used metabolic indices, homeostasis model assessment of insulin resistance (HOMA-IR), plasma atherogenic index (PAI), triglyceride–glucose (TyG) index, and metabolic score for insulin resistance (METS-IR), in relation to calcium oxalate stone formation. A total of 1206 adults (666 stone formers and 540 non-stone formers) were enrolled across seven tertiary centers, and calcium oxalate stone composition was confirmed by stone analysis. Metabolic indices were calculated using established formulas. Receiver-operating characteristic analyses and multivariable logistic regression models adjusted for age, sex, body mass index, hypertension, and diabetes mellitus were performed. HOMA-IR, PAI, and METS-IR demonstrated statistically significant but very limited discriminatory capacity, with AUC values only marginally exceeding 0.50, whereas TyG did not show significant discriminatory performance. In adjusted analyses, PAI (OR 1.72, 95%CI 1.09–2.71) and METS-IR (OR 1.05, 95%CI 1.01–1.08) were independently associated with stone formation, while HOMA-IR and TyG were not. These findings suggest that composite metabolic indices integrating lipid metabolism and adiposity may better reflect the metabolic milieu associated with calcium oxalate stone disease than glucose-centered insulin resistance markers alone. Although their standalone discriminatory performance is very limited, these indices may provide pathophysiological insights and serve as hypothesis-generating tools for future research.</p>

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Composite metabolic indices and calcium oxalate stone formation: a multicenter comparative study of HOMA-IR, PAI, TyG, and METS-IR

  • 期刊论文

  • 发表日期：

    2026年5月20日

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  • Muhammed Arif Ibis,
  • Rifat Burak Ergul,
  • Selim Soytürk,
  • Yasin Yitgin,
  • Cagrı Akpinar,
  • Tzevat Tefik,
  • Omer Onur Cakır,
  • Murat Can Kiremit,
  • Selcuk Guven,
  • Kemal Sarica,
  • Mehmet Ilker Gokce

摘要

Urolithiasis has been increasingly recognized as a manifestation of systemic metabolic dysfunction rather than solely a local urinary disorder. In this multicenter cross-sectional study, we evaluated and compared the associations and discriminatory performance of four commonly used metabolic indices, homeostasis model assessment of insulin resistance (HOMA-IR), plasma atherogenic index (PAI), triglyceride–glucose (TyG) index, and metabolic score for insulin resistance (METS-IR), in relation to calcium oxalate stone formation. A total of 1206 adults (666 stone formers and 540 non-stone formers) were enrolled across seven tertiary centers, and calcium oxalate stone composition was confirmed by stone analysis. Metabolic indices were calculated using established formulas. Receiver-operating characteristic analyses and multivariable logistic regression models adjusted for age, sex, body mass index, hypertension, and diabetes mellitus were performed. HOMA-IR, PAI, and METS-IR demonstrated statistically significant but very limited discriminatory capacity, with AUC values only marginally exceeding 0.50, whereas TyG did not show significant discriminatory performance. In adjusted analyses, PAI (OR 1.72, 95%CI 1.09–2.71) and METS-IR (OR 1.05, 95%CI 1.01–1.08) were independently associated with stone formation, while HOMA-IR and TyG were not. These findings suggest that composite metabolic indices integrating lipid metabolism and adiposity may better reflect the metabolic milieu associated with calcium oxalate stone disease than glucose-centered insulin resistance markers alone. Although their standalone discriminatory performance is very limited, these indices may provide pathophysiological insights and serve as hypothesis-generating tools for future research.