Association of dynamic change of triglyceride-glucose index during hospital stay with all-cause mortality in critically ill patients: a retrospective cohort study from MIMIC IV2.0

Associations between triglyceride-glucose indices and delirium risk in critically ill patients with acute kidney injury: a retrospective study

Background

Delirium frequently occurs in individuals with acute kidney injury (AKI), leading to serious adverse outcomes. However, there are currently no predictors of early intervention for delirium in clinical practice. This study aims to investigate whether a correlation exists between TyG indices and the clinical symptoms of delirium in patients with AKI.

Methods

Eligible participants diagnosed with AKI from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database were categorised based on their TyG index. The primary outcome of this study was the incidence of delirium. The TyG indices were quartile and Kaplan-Meier (K-M) cumulative curve was conducted to compare the consequence of each group. Cox proportional hazards and restricted cubic spline (RCS) analyses were employed to explore the associations between TyG indices and outcomes. To mitigate potential biases, a no-replacement propensity score matching (PSM) approach was employed. Subgroup analyses were conducted to explore differences across various demographic and clinical categories.

Results

A positive correlation between the quartile groupings of TyG-AVG and an increased cumulative incidence of delirium in individuals with severe AKI, as demonstrated through K-M cumulative curves and Cox regression analysis. Regarding the TyG index, patients in the 4th group displayed the highest hazard of delirium in both of the methods mentioned above. Furthermore, RCS analysis indicated that the interaction between the two variables is approximately linear. Subgroup analyses revealed that the effects of both metrics remained consistent across most examined subgroups.

Conclusion

Higher TyG indices were clearly associated with the incidence of delirium in patients with severe AKI. These indices could serve as valuable tools for identifying delirium-prone individuals with AKI.

The relationship and differences in the triglyceride-glucose index and all-cause mortality in patients with coronary heart disease combined with cerebrovascular and other comorbidities: an analysis of the MIMIC-IV database

Objective

This study aims to investigate the predictive capability of the triglyceride-glucose index (TyG index) for all-cause mortality among patients with coronary heart disease (CHD), particularly in those with cerebrovascular disease (CVD) and other comorbidities, based on the MIMIC-IV database.

Methods

Using the ICD-9/10 coding standards, eligible CHD patients were identified from the MIMIC-IV database (version 3.0) with defined inclusion and exclusion criteria to ensure sample representativeness. Patients were categorized into CVD and other comorbidity groups. Data on mortality rates at 90 days, 1 year, and overall were collected, along with the TyG index and relevant covariates associated with survival risk. Baseline analyses, Spearman correlation, and restricted cubic splines (RCS) were employed to assess the nonlinear relationship between the TyG index and mortality. Kaplan-Meier curves and Cox proportional hazards models were utilized to evaluate survival risk.

Results

A total of 1,872 CHD patients were included, with 578 having CVD and a mortality rate of 50.17%; 1,294 had other comorbidities with a mortality rate of 64.91%. RCS analysis indicated a nonlinear relationship between the TyG index and mortality risk. For patients with concurrent CVD, the lowest mortality risk occurred at a TyG index of 9.37 mmol/L, while for those with other comorbidities, the lowest risk was observed at 9.36 mmol/L. Cox regression analysis revealed a significant association between the TyG index and survival risk in all CHD patients (HR = 1.15, 95%CI: 1.04-1.28, P < 0.01). In patients with other comorbidities, an increase in the TyG index was significantly correlated with elevated mortality risk (HR = 1.21, 95%CI: 1.02-1.34, P < 0.01).

Conclusion

The TyG index exhibits a nonlinear relationship with mortality risk in CHD patients, with elevated levels significantly increasing mortality risk in those with other comorbidities. These findings suggest that the TyG index may serve as a critical metabolic marker for prognostic evaluation in CHD patients, warranting further clinical attention.

Triglyceride-glucose index and prognosis in non-diabetic critically ill patients: data from the eICU database

Background

The triglyceride-glucose (TyG) index is a marker for insulin resistance (IR) linked to diabetes complications and poor outcomes. Its connection to all-cause mortality in non-diabetic critically ill patients is unknown. This study aims to investigate the TyG index's impact on mortality in this population, evaluating how IR affects their prognosis.

Methods

This study is retrospective observational research utilizing data from the eICU Collaborative Research Database. A total of 14,089 non-diabetic critically ill patients were included and categorized into three groups based on the TyG index measured on the first day of admission (T1, T2, and T3). Kaplan-Meier survival analysis was performed to compare the 28-day mortality rates among the different groups. Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Additionally, we conducted sensitivity analyses, subgroup analyses, and interaction analyses to assess the robustness of the results.

Results

During the observation period, 730 patients (5.18%) died in the ICU, while 1,178 patients (8.36%) died in the hospital. The 28-day ICU mortality rate and hospital mortality rate significantly increased with higher TyG index values (P < 0.001). Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Specifically, Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Furthermore, the analysis showed a nonlinear effect of the TyG index on mortality in non-diabetic critically ill patients, with a critical point at 9.94. While Below 9.94, ICU and hospital mortality rates rose with higher TyG index values. But above 9.94, mortality didn't significantly increase despite further rises in the TyG index. Sensitivity and subgroup analyses confirmed the robustness of these results, and E-value analysis indicated strong resistance to unmeasured confounding factors.

Conclusion

The TyG index demonstrates a significant positive correlation with all-cause mortality in non-diabetic critically ill patients, exhibiting a nonlinear relationship. Consequently, the TyG index serves as a crucial tool for identifying high-risk patients, thereby assisting clinicians in formulating more effective monitoring and intervention strategies.

Association between triglyceride-glucose index and all-cause mortality in patients with congestive heart failure and atrial fibrillation

Background

The role of the triglyceride-glucose (TyG) index in critically ill patients with congestive heart failure (CHF) and atrial fibrillation (AF), requiring intensive care unit (ICU) admission, remains unclear. This study aimed to investigate the association between the TyG index and the clinical prognosis of critically ill patients with CHF and AF.

Methods

This retrospective observational cohort study utilized data from the Medical Information Mart for Intensive Care-IV (MIMIC IV2.2) database. Participants were categorized into four groups based on TyG index level. The primary outcome was hospital all-cause mortality. Multivariable logistic proportional regression analysis and restricted cubic spline regression were employed to assess the TyG index's association with hospital mortality in patients with CHF and AF. Sensitivity analysis included determining the TyG index's feature importance through subgroup analysis in different subgroups.

Results

A total of 787 patients were included in the study, with hospital and ICU mortalities of 14.2% and 8.3%, respectively. Multivariate logistic regression analysis demonstrated that the TyG index was independently associated with an increased risk of hospital mortality (odds ratio (OR), 1.59 [95% confidence interval (CI) 1.15-2.19], P = 0.005) and ICU mortality [OR 1.9; (95% CI 1.28-2.83), P = 0.001] after adjusting for confounders. The restricted cubic spline regression model indicated a linear increase in the risks of in-hospital and ICU mortality with a higher TyG index. Sensitivity analysis revealed consistent effect sizes and directions in different subgroups, ensuring result stability.

Conclusions

The results of our study suggest a significant association between the TyG index and hospital and ICU all-cause mortality in critically ill patients with CHF and AF. This finding implies that the TyG index could potentially serve as a valuable tool for identifying patients with CHF and AF at an elevated risk of all-cause mortality.

Association Between Triglyceride Glucose Index and Risk of Carotid Plaques in Asia: A Systematic Review and Meta-Analysis

The triglyceride glucose (TyG) index is used to assess insulin resistance, which is associated with the occurrence and development of cardiovascular diseases, but the risk of carotid plaques is controversial in Asia. We searched PubMed, Embase, Scopus, and Cochrane Library for articles published up to October 15, 2023, to assess the association and dose-response association of the TyG index with the risk of carotid plaques in Asia. The random effects model was used to calculate the effect estimates and 95% confidence intervals (CIs). A total of 534 articles were retrieved, and eleven studies were selected, involving 145 218 Asian participants. When the TyG index was analyzed as a categorical variable, compared with the low TyG index, the high TyG index increased the risk of carotid plaques (OR=1.38, 95% CI: 1.20, 1.60, p<0.001). As continuous variables were analyzed, similar results were observed (OR=1.33, 95% CI: 1.22, 1.45, p<0.001). Meanwhile, dose-response analysis showed that the risk of carotid plaque increased by 1.03 times for every unit increase in the TyG index (RR=1.03, 95% CI: 1.02, 1.03, p<0.001). Our meta-analysis indicates an association between the TyG index and the risk of carotid plaques in Asia. Further studies are required to substantiate these findings.

Relationship between atherogenic index of plasma and length of stay in critically ill patients with atherosclerotic cardiovascular disease: a retrospective cohort study and predictive modeling based on machine learning

BACKGROUND

The atherogenic index of plasma (AIP) is considered an important marker of atherosclerosis and cardiovascular risk. However, its potential role in predicting length of stay (LOS), especially in patients with atherosclerotic cardiovascular disease (ASCVD), remains to be explored. We investigated the effect of AIP on hospital LOS in critically ill ASCVD patients and explored the risk factors affecting LOS in conjunction with machine learning.

METHODS

Using data from the Medical Information Mart for Intensive Care (MIMIC)-IV. AIP was calculated as the logarithmic ratio of TG to HDL-C, and patients were stratified into four groups based on AIP values. We investigated the association between AIP and two key clinical outcomes: ICU LOS and total hospital LOS. Multivariate logistic regression models were used to evaluate these associations, while restricted cubic spline (RCS) regressions assessed potential nonlinear relationships. Additionally, machine learning (ML) techniques, including logistic regression (LR), decision tree (DT), random forest (RF), extreme gradient boosting (XGB), and light gradient boosting machine (LGB), were applied, with the Shapley additive explanation (SHAP) method used to determine feature importance.

RESULTS

The study enrolled a total of 2423 patients with critically ill ASCVD, predominantly male (54.91%), and revealed that higher AIP values were independently associated with longer ICU and hospital stays. Specifically, for each unit increase in AIP, the odds of prolonged ICU and hospital stays were significantly higher, with adjusted odds ratios (OR) of 1.42 (95% CI, 1.11-1.81; P = 0.006) and 1.73 (95% CI, 1.34-2.24; P < 0.001), respectively. The RCS regression demonstrated a linear relationship between increasing AIP and both ICU LOS and hospital LOS. ML models, specifically LGB (ROC:0.740) and LR (ROC:0.832) demonstrated superior predictive accuracy for these endpoints, identifying AIP as a vital component of hospitalization duration.

CONCLUSION

AIP is a significant predictor of ICU and hospital LOS in patients with critically ill ASCVD. AIP could serve as an early prognostic tool for guiding clinical decision-making and managing patient outcomes.

Triglyceride-glucose index and the risk of in-hospital and ICU all-cause mortality: a systematic review and meta-analysis of observational studies

Several studies have illustrated the association of the triglyceride glucose (TyG) index with in-hospital and intensive care unit (ICU) mortality. However, no studies have compiled this evidence and reached a conclusion. This study aimed to quantify the association of the TYG index with the risk of in-hospital and ICU mortality. An extensive search of databases including PubMed, Scopus, and Web of Science, was performed up to 21 Jan 2024. Nineteen studies were included in the meta-analysis. The outcomes were in-hospital mortality in 18 studies and ICU mortality in 8 studies. Among the 42,525 participants, 5233 in-hospital and 1754 ICU mortality cases were reported. The pooled analysis revealed that each unit increase in the TYG index was associated with a 33% and 45% increase in the risk of in-hospital (RR = 1.33; 95% CI: 1.23, 1.43; I squared = 90.3%) and ICU (RR: 1.45; 95% CI: 1.25, 1.67; I squared = 44.8%) mortality, respectively. Subgroup analysis revealed a stronger association between the TYG index and the risk of in-hospital mortality in patients with cardiovascular diseases than in those with cerebrovascular diseases (Pheterogeneity between Groups = 0.014). The findings of this study showed a positive association between the TyG index and the risk of in-hospital and ICU mortality. (PROSPERO registration ID: CRD420245414390).

Joint association of TyG index and LDL-C with all-cause and cardiovascular mortality among patients with cardio-renal-metabolic disease

Both triglyceride-glucose (TyG) index, as a surrogate marker of insulin resistance, and low-density lipoprotein cholesterol (LDL-C) are independent risk factors for long-term prognosis among patients with cardio-renal-metabolic (CRM) disease. However, the co-exposures of TyG index and LDL-C to mortality is unclear. The aim of this study is to investigate the joint effects and risk stratification of the TyG index and LDL-C on all-cause and cardiovascular mortality in CRM patients. We analyzed CRM patients from the National Health and Nutrition Examination Survey (NHANES) database (1999-2018), calculating TyG index as Ln[fasting triglyceride (mg/dL)×fasting glucose (mg/dL)/2] and using multivariable Cox regression models to assess the joint effects of TyG index and LDL-C on all-cause and cardiovascular mortality. The interaction between the TyG index and LDL-C to mortality was also evaluated. During a median follow-up of 7.6 years, 22.8% and 8.4% of patients died from all-cause and cardiovascular causes, respectively. Among patients with LDL-C < 2.6 mmol/L, no significant differences were observed in all-cause and cardiovascular mortality when comparing higher TyG index to the lowest tertile (T1). Specifically, the hazard ratio (HR) for all-cause mortality in the second (T2) and third tertiles (T3) were 0.81 (95% confidence interval(CI): 0.59-1.09) and 0.87 (95%CI: 0.62-1.22), respectively, with a P for trend of 0.468. For cardiovascular mortality, the HR for T2 and T3 compared to T1 were 0.80 (95%CI: 0.48-1.32) and 0.72 (95%CI: 0.45-1.15), respectively, with a P for trend of 0.173. However, elevated TyG index was related to markedly increased risk of all-cause and cardiovascular mortality in patients with LDL-C ≥ 2.6 mmol/L. Specifically, for all-cause mortality, HR for T2 and T3 compared to T1 were 1.01 (95%CI: 0.79-1.28) and 1.38 (95%CI: 1.07-1.79), respectively, with a P for trend of 0.009. For cardiovascular mortality, the HR was 1.09 (95% CI: 0.72-1.65) for T2 and 1.80 (95% CI: 1.18-2.75) for T3, with a P for trend of 0.005. Interactive analysis also demonstrated that a significant association of TyG index and LDL-C with the risk of all-cause (P for interaction = 0.011) and cardiovascular (P for interaction = 0.050) mortality was observed. The findings highlight that elevated TyG index can significantly increase the risk of all-cause and cardiovascular mortality only among CRM patients with LDL-C ≥ 2.6 mmol/L, but not among patients with LDL-C < 2.6 mmol/L.

Joint association of triglyceride glucose index (TyG) and a body shape index (ABSI) with stroke incidence: a nationwide prospective cohort study

BACKGROUND

Triglyceride glucose index(TyG) and a body shape index(ABSI) are both independent predictor of stroke incidence or adverse prognosis but these two indicators seldom were combined to predict. The purpose of this study is to evaluate whether the combination of TyG and ABSI better predict the incidence of stroke.

METHODS

Based on the China Health and Retirement Longitudinal Study(CHARLS), 8,257 people aged 45 years and older without stroke were enrolled and followed up to 9 years. Sociodemographic information, health status, physical examination and blood data were collected retrospectively. Cox regressions were to determine the relationship between different groups and stroke incidence, using receiver operating characteristic curves to evaluate the diagnostic value. Meanwhile, subgroup analysis was performed to investigate the prediction performance among different population.

RESULTS

672(8.14%) of 8,257 participants had stroke incidence during 9 years. In the adjusted multivariate cox regression model, both TyG and ABSI were still predictors of stroke. The HR of TyG was 1.25(95%CI: 1.06-1.47) and the HR of ABSI was 1.33(95%CI: 1.06-1.68). Restricted cubic spline regression showed the associations between TyG or ABSI and stroke. The combination of TyG and ABSI had the highest diagnostic efficacy(AUC: 0.579, 95%CI: 0.553-0.597), compared to TyG(AUC:0.566, 95%CI: 0.544-0.587) and ABSI(AUC:0.533, 95%CI: 0.524-0.597). Kaplan-Meier curves showed that the highest cumulative stroke incidence was among people with high TyG and ABSI(TyG ≥ 8.5742, ABSI ≥ 0.0852; P < 0.0001), which had the highest HR of stroke incidence(HR:1.64, 95%CI:1.2-2.24).

CONCLUSION

The combined prediction of TyG and ABSI had higher clinical value and enabled earlier detection of the stroke in the general population, which could be monitored and intervened to reduce the overall burden of stroke.

Association of cardiovascular-kidney-metabolic index with all-cause mortality during hospitalization in critically ill patients: a retrospective cohort study from MIMIC IV2.2

Background

The cardiovascular-kidney-metabolic index (CKMI), a novel functional indicator proposed in this study, aims to accurately reflect the functional status of the heart, kidneys, and metabolism. However, its ability to predict mortality risk in critically ill patients during their stay in the intensive care unit (ICU) remains uncertain. Therefore, this study aims to validate the correlation between the CKMI during hospitalization and all-cause mortality.

Methods

The study utilized the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV) dataset for a retrospective analysis of cohorts. The cohorts were divided into quartiles based on CKMI index levels. The primary endpoint was all-cause mortality during ICU and hospital stay, while secondary endpoints included the duration of ICU stay and overall hospitalization period. We established Cox proportional hazards models and employed multivariable Cox regression analysis and restricted cubic spline (RCS) regression analysis to explore the relationship between CKMI index and all-cause mortality during hospitalization in critically ill patients. Additionally, subgroup analyses were conducted based on different subgroups.

Results

The study enrolled 1,576 patients (male 60.79%). In-patient and ICU mortality was 11.55% and 6.73%. Multivariate COX regression analysis demonstrated a significant negative correlation between CKMI index and the risk of hospital death [HR, 0.26 (95% CI 0.07-0.93), P = 0.038] and ICU mortality [HR, 0.13 (95% CI 0.03-0.67), P = 0.014].RCS regression model revealed that in-hospital mortality (P-value =0.015, P-Nonlinear =0.459) and ICU mortality (P-value =0.029, P-Nonlinear =0.432) increased linearly with increasing CKMI index. Subgroup analysis confirmed consistent effect size and direction across different subgroups, ensuring stable results.

Conclusion

Our research findings suggest that a higher CKMI index is associated with a significant reduction in both in-hospital and ICU mortality among critically ill patients. Therefore, CKMI index emerges as a highly valuable prognostic indicator for predicting the risk of in-hospital death in this population. However, to strengthen the validity of these results, further validation through larger-scale prospective studies is imperative.

Correlation of the triglyceride-glucose index and heart rate with 28-day all-cause mortality in severely ill patients: analysis of the MIMIC-IV database

BACKGROUND

Research has identified a link between the triglyceride-glucose index (TyG-i) and the risk of mortality in severely ill patients. However, it remains uncertain if the TyG-i affects mortality by influencing heart rate (HR).

METHODS

This study enrolled 3,509 severely ill participants from the Medical Information Mart for Intensive Care (MIMIC-IV) database who had triglyceride, glucose, and HR data upon entering the ICU. Cox regression models were applied to estimate the effect of the TyG-i and HR on 28-day all-cause mortality (ACM) and 28-day in-hospital mortality (IHM). Additionally, Kaplan-Meier (K-M) survival analysis was employed to explore outcome variations among different patient groups. The association of the TyG-i with HR, Sequential Organ Failure Assessment (SOFA) score, and Simplified Acute Physiology Score (SAPS) II was explored through linear regression analysis. Subgroup analysis explored potential interactions among patient characteristics, while sensitivity analysis gauged the robustness of the findings. Additionally, mediation analysis was conducted to assess whether elevated HR acts as an intermediary factor linking the TyG-i to both 28-day ACM and 28-day IHM.

RESULTS

During the 28-day follow-up, 586 cases (16.7%) died from all causes, and 439 cases (12.5%) died during hospitalisation. Cox results showed that individuals with a heightened TyG-i and elevated HR had the highest 28-day ACM (Hazard Ratio 1.70, P-value below 0.001) and 28-day IHM (Hazard Ratio 1.72, P-value below 0.001) compared to those with a reduced TyG-i and HR. The K-M curves showed that individuals with low TyG-i and low HR had the lowest incidence of 28-day ACM and 28-day IHM. The linear analysis results evidenced that the TyG-i was independently connected to HR (beta = 3.05, P-value below 0.001), and the TyG-i was also independently associated with SOFA score (beta = 0.39, P-value below 0.001) and SAPS II (beta = 1.79, P-value below 0.001). Subgroup analysis revealed a significant association in participants without hypertension, the interaction of an elevated TyG-i and HR strongly correlated with a higher 28-day death risk (interaction P-value below 0.05). Furthermore, HR mediated 29.5% of the connection between the TyG-i and 28-day ACM (P-value = 0.002), as well as 20.4% of the connection between the TyG-i and 28-day IHM (P-value = 0.002).

CONCLUSION

For severely ill patients, the TyG-i is distinctly correlated with HR, and elevated levels of both are strongly connected to greater 28-day ACM and 28-day IHM risks, especially in patients without hypertension. Furthermore, elevated HR mediates the connection between the TyG-i and 28-day mortality.

Association of the Triglyceride-Glucose Index With Resistant Hypertension and a Nomogram Model Construction

BACKGROUND

Resistant hypertension (RH) remains one of the major risk factors for cardiovascular disease. This study aims to investigate the association between the triglyceride-glucose (TyG) index and RH incidence in patients with hypertension and to construct a nomogram for predicting the occurrence of RH.

METHODS AND RESULTS

A retrospective cohort study was conducted on 1635 patients initially diagnosed with hypertension at the Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University from August 2019 to August 2021. Patients were followed up for a median of 31 months, with 373 cases (22.81%) developing RH. Least absolute shrinkage and selection operator regression and multivariable Cox regression analysis identified the TyG index as the strongest predictor of RH (hazard ratio, 5.472 [95% CI, 4.028-7.433]; P<0.001). Consistent results were also observed in subgroup analyses across different ages and sexes. In addition to the TyG index, other independent risk factors, including uric acid, age, and the apnea-hypopnea index, were noted. A nomogram model was subsequently developed using these risk factors, and including the TyG index notably enhanced the diagnostic effectiveness of the model in predicting the occurrence of RH.

CONCLUSIONS

The TyG index appears to be a potential predictor of RH in patients with hypertension, indicating that insulin resistance might be an important factor in the development and progression of RH.

Predictive value of the triglyceride-glucose index for short- and long-term all-cause mortality in patients with critical coronary artery disease: a cohort study from the MIMIC-IV database

BACKGROUND

Triglyceride-glucose (TyG) index is linked to a poor prognosis for cardiovascular condition and is a valid indicator of insulin resistance. This study evaluated the potential predicting usefulness of the TyG index for all-cause mortality, both short- and long-term, for those concerning critical coronary artery disease (CAD).

METHODS

In this study, information from 5452 critically-ill individuals with CAD in intensive care units were gathered from the Medical Information Marketplace in Intensive Care (MIMIC-IV) database. Depending on the TyG index degree, the patients were categorized into three categories. Clinical outcomes included short-term (30-day) and long-term (365-day) all-cause mortality. The corresponding relationships involving the TyG index and clinical outcomes were examined by deploying restricted cubic spline (RCS) regression analysis and Cox proportional risk regression.

RESULTS

An increased TyG index was associated with increased 30-day (Tertile 1: 6.1%, Tertile 2: 7.3%, Tertile 3: 9.2%, P = 0.001) and 365-day (Tertile 1: 15.2%, Tertile 2: 17.0%, Tertile 3: 19.6%, P = 0.002) death rates across all causes. Cox regression with multiple variables indicates that higher TyG indices were linked to higher all-caused mortality hazard ratios throughout the short and long terms, with a larger predictive value for the former. RCS regression analyses suggested that the risk of death was notably and linearly that is associated with TyG index.

CONCLUSIONS

The TyG index is a reliable predictor of all-cause mortality at different stages in critically ill CAD patients, with a higher predictive ability for short-term mortality. Early intervention in patients with elevated TyG index may improve their survival outcomes. Future research should delve into understanding its pathophysiological mechanisms and develop intervention strategies based on the TyG index, providing new insights and strategies to enhance the outlook for critically ill CAD patients.

Association of triglyceride-glucose index and delirium in patients with sepsis: a retrospective study

OBJECTIVE

It is well known that glucose and lipid metabolism disorders and insulin resistance are common in sepsis, which affect the occurrence and prognosis of multiple organ dysfunction in septic patients. Previous study reported the predictive value of triglyceride-glucose index (TyG), a clinical indicator for insulin resistance, in postoperative delirium patients. However, it remains unclear whether the TyG index is a novel predictive biomarker for sepsis-associated delirium. The aim of this study is to explore the relationship between TyG index and the risk of delirium in patients with sepsis.

METHODS

Adult septic patients were identified from the MIMIC-IV database and divided into four groups based on the mean value of TyG. The primary outcome was the incidence of delirium. The association between TyG and the risk of developing delirium was evaluated by restricted cubic spline (RCS), multivariate logistic regression and subgroup analysis. Propensity Score Matching (PSM) method was used to balance the baseline data.

RESULTS

A total of 3,331 septic patients were included in the analysis, and further divided into four groups: Q1 (TyG ≤ 8.67), Q2 (8.67 < TyG ≤ 9.08), Q3 (9.08 < TyG ≤ 9.61), and Q4 (TyG > 9.61). The RCS curves demonstrated a non-linear positive relationship between TyG index and the risk of developing delirium, and an optimal cut-of value 9.09 was recommended. After balancing the baseline information by PSM, patients in the TyG > 9.09 group had a significant higher incidence of delirium compared with those in the TyG ≤ 9.09 group. In logistic regression analysis, TyG > 9.09 was significantly associated with lower risk of developing delirium in both original cohort (OR 1.54-1.78, all P < 0.001) and the PSM cohort (OR 1.41-1.48, all P < 0.001). No association was found between the TyG index and mortality (all P > 0.05). In subgroup analysis, our findings were consistent (all OR > 1 in all subgroups).

CONCLUSION

Our study demonstrated an independent association between TyG index and increased risk of delirium in septic patients, indicating that TyG index can serve as a biomarker for delirium in sepsis.

U-shaped association between triglyceride-glucose index and all-cause mortality among critically ill pediatrics: a population-based retrospective cohort study

BACKGROUND

Previous studies have shown that an elevated triglyceride-glucose (TyG) index was associated with all-cause mortality in both general adult individuals and critically ill adult patients. However, the relationship between the TyG index and clinical prognosis in pediatric patients admitted to the intensive care unit (ICU) remains unknown. We aimed to investigate the association of the TyG index with in-hospital all-cause mortality in critically ill pediatric patients.

METHODS

A total of 5706 patients in the Pediatric Intensive Care database were enrolled in this study. The primary outcome was 30-day in-hospital all-cause mortality, and secondary outcome was 30-day in-ICU all-cause mortality. The restricted cubic spline (RCS) curves and two-piecewise multivariate Cox hazard regression models were performed to explore the relationship between the TyG index and outcomes.

RESULTS

The median age of the study population was 20.5 [interquartile range (IQR): 4.8, 63.0] months, and 3269 (57.3%) of the patients were male. The mean TyG index level was 8.6 ± 0.7. A total of 244 (4.3%) patients died within 30 days of hospitalization during a median follow-up of 11 [7, 18] days, and 236 (4.1%) patients died in ICU within 30 days of hospitalization during a median follow-up of 6 [3, 11] days. The RCS curves indicated a U-shape association between the TyG index and 30-day in-hospital and in-ICU all-cause mortality (both P values for non-linear < 0.001). The risk of 30-day in-hospital all-cause mortality was negatively correlated with the TyG index until it bottoms out at 8.6 (adjusted hazard ratio [HR], 0.72, 95% confidence interval [CI] 0.55-0.93). However, when the TyG index was higher than 8.6, the risk of primary outcome increased significantly (adjusted HR, 1.51, 95% CI 1.16-1.96]). For 30-day in-ICU all-cause mortality, we also found a similar relationship (TyG < 8.6: adjusted HR, 0.75, 95% CI 0.57-0.98; TyG ≥ 8.6: adjusted HR, 1.42, 95% CI 1.08-1.85). Those results were consistent in subgroups and various sensitivity analysis.

CONCLUSIONS

Our study showed that the association between the TyG index and 30-day in-hospital and in-ICU all-cause mortality was nonlinear U-shaped, with a cutoff point at the TyG index of 8.6 in critically ill pediatric patients. Our findings suggest that the TyG index may be a novel and important factor for the short-term clinical prognosis in pediatric patients.

Triglyceride-glucose index predicts sepsis-associated acute kidney injury and length of stay in sepsis: A MIMIC-IV cohort study

Background

Inflammation and stress response may be related to the occurrence of sepsis-associated acute kidney injury (SA-AKI) in patients with sepsis.Insulin resistance (IR) is closely related to the stress response, inflammatory response, immune response and severity of critical diseases. We assume that the triglyceride-glucose (TyG) index, an alternative indicator for IR, is associated with the occurrence of SA-AKI in patients with sepsis.

Methods

Data were obtained from The Medical Information Mart for Intensive Care-IV(MIMIC-IV) database in this retrospective cohort study. Univariate and multivariate logistic regression analysis and multivariate restricted cubic spline(RCS) regression were conducted to evaluate the association between TyG index and SA-AKI, length of stay (LOS). Subgroup and sensitivity analyses were performed to verify the robustness of the results.

Results

The study ultimately included data from 1426 patients with sepsis, predominantly of white ethnicity (59.2%) and male sex (56.4%), with an SA-AKI incidence rate of 78.5%. A significant linear association was observed between the TyG index and SA-AKI (OR, 1.40; 95% confidence interval(CI) [1.14-1.73]). Additionally, the TyG index demonstrated a significant correlation with the length of stay (LOS) in both the hospital (β, 1.79; 95% CI [0.80-2.77]) and the intensive care unit (ICU) (β, 1.30; 95% CI [0.80-1.79]). Subgroup and sensitivity analyses confirmed the robustness of these associations.

Conclusion

This study revealed a strong association between the TyG index and both SA-AKI and length of stay in patients with sepsis. These findings suggest that the TyG index is a potential predictor of SA-AKI and the length of hospitalization in sepsis cases, broadening its application in this context. However, further research is required to confirm whether interventions targeting the TyG index can genuinely enhance the clinical outcomes of patients with sepsis.

Relationship between TyG index and the degree of coronary artery lesions in patients with H-type hypertension

BACKGROUND

The TyG index, a prominent metric for assessing insulin resistance, has gained traction as a prognostic tool for cardiovascular disease. Nevertheless, the understanding of the prognostic significance of the extent of coronary artery stenosis in individuals afflicted with H-type hypertension remains limited.

METHODS

A retrospective study was conducted at Wuhan Third Hospital, including a cohort of 320 inpatients who were diagnosed with hypertension in combination with coronary artery disease. The study period spanned from January 1, 2021, to February 1, 2023. The study cohort was stratified based on the severity of stenosis into three distinct groups: low stenosis, medium stenosis, and high stenosis, as determined by the Gensini score derived from coronary angiography findings. The present study aimed to investigate the association between the severity of coronary stenosis and the number of lesion branches, utilizing the TyG index as a testing indicator. The predictive ability of TyG for coronary lesion severity was assessed using logistic regression analysis.

RESULTS

The results of our study indicate a positive correlation between elevated levels of TyG and an increased susceptibility to severe stenosis in individuals diagnosed with H-type hypertension. Upon careful consideration of potential confounding variables, it has been observed that the TyG index exhibits a robust association with the likelihood of severe stenosis in individuals with H-type hypertension (odds ratio [OR] = 4000, 95% confidence interval CI 2.411-6.635, p = 0.0001), as well as the prevalence of multivessel disease (OR = 1.862, 95% CI 1.036-3.348, p < 0.0001). The TyG index demonstrated superior predictive ability for severe coronary stenosis in patients with H-type hypertension compared to those without H-type hypertension (area under the curve [AUC] = 0.888, 95% confidence interval CI 0.838-0.939, p < 0.0001, versus AUC = 0.615, 95% CI 0.494-0.737, p < 0.05).

CONCLUSION

The TyG index is an independent risk factor for the degree of coronary stenosis and a better predictor in patients with H-type hypertension combined with coronary artery disease.

Triglyceride-glucose index as a valuable predictor for aged 65-years and above in critical delirium patients: evidence from a multi-center study

BACKGROUND

The triglyceride-glucose index (TyG), an established indicator of insulin resistance, is closely correlated with the prognosis of several metabolic disorders. This study aims to investigate the association between the TyG index and the incidence of critical delirium in patients aged 65 years and older.

METHODS

We focused on evaluating patients aged 65 years and older diagnosed with critical delirium. Data were obtained from the Medical Information Database for Intensive Care (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD). Multivariate logistic regression and restricted cubic spline (RCS) regression were used to determine the relationship between the TyG index and the risk of delirium.

RESULTS

Participants aged 65 years and older were identified from the MIMIC-IV (n = 4,649) and eICU-CRD (n = 1,844) databases. Based on optimal thresholds derived from RCS regression, participants were divided into two cohorts: Q1 (< 8.912), Q2 (≥ 8.912). The logistic regression analysis showed a direct correlation between the TyG index and an increased risk of critical delirium among ICU patients aged 65 and older. These findings were validated in the eICU-CRD dataset, and sensitivity analysis further strengthened our conclusions. In addition, the subgroup analysis revealed certain differences.

CONCLUSION

This study highlights a clear, independent relationship between the TyG index and the risk of critical delirium in individuals aged 65 years and older, suggesting the importance of the TyG index as a reliable cardio-cerebrovascular metabolic marker for risk assessment and intervention.