Association between triglyceride-glucose index and all-cause mortality in critically ill patients with ischemic stroke: analysis of the MIMIC-IV database

Investigation of the connection between triglyceride-glucose (TyG) index and the risk of acute kidney injury in septic patients - a retrospective analysis utilizing the MIMIC-IV database

The TyG index serves as a valuable tool for evaluating insulin resistance. An elevated TyG has shown a strong association with the occurrence of acute kidney injury (AKI). Nevertheless, existing literature does not address the relationship between the TyG index and acute kidney injury in patients with sepsis. Sepsis patients were identified from the MIMIC-IV database and categorized into four groups according to quadrilles of their TyG index values. The primary outcome of this study was the incidence of AKI. The relationship between the TyG index and the risk of AKI in septic patients was evaluated using Cox proportional hazards and restricted cubic spline models. Subgroup analyses were conducted to investigate the prognostic value of the TyG index in different subgroups. A total of 2,616 patients with sepsis (57% of whom were male) were included in this study. The incidence of AKI was found to be 78%. Cox proportional hazards analysis revealed a significant correlation between the TyG index and the occurrence of AKI in septic patients. Furthermore, a restricted cubic spline model revealed an approximately linear relationship between a higher TyG index and an elevated risk of AKI in septic patients. The trend of the hazard ratio (HR) remained consistent across various subgroups. These findings emphasize the reliability of the TyG index as an independent predictor for the occurrence of AKI and unfavorable renal outcomes in sepsis patients. Nevertheless, establishing a causal relationship between the two requires demonstration through larger prospective studies.

Correlation between monocyte and length of in-hospital stay in patients with allergic rhinitis: data from the MIMIC-IV database

BACKGROUND

This study aimed to explore the factors associated with the length of in-hospital stay (LOS) in allergic rhinitis (AR).

METHODS

Patients with AR and related data were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The influencing factors of LOS were determined by correlation analysis and linear regression. We ranked the importance of significant variables. Finally, mediation analysis was performed to explore the potential mediating factors associated with LOS.

RESULTS

This retrospective study enrolled 937 patients diagnosed with AR. Correlation analysis showed that 10 variables were closely correlated with the LOS. Linear regression further showed that albumin, white blood cell (WBC), red blood cell (RBC), red cell distribution width (RDW), total Ca, and monocyte were independently related to the LOS (all P < 0.05). After considering comorbidities, monocyte, albumin, WBC, RBC, total Ca, and Charlson comorbidity index were independent factors for LOS (all P < 0.05). The permutation importance exhibited that monocyte was the most important variable. Finally, mediation analysis demonstrated that WBC played a mediating role in the relationship between monocytes and LOS.

CONCLUSION

Monocyte level is related to the LOS of patients with AR, and their relationship can be mediated by WBC. Medical and nursing staff can stratify AR management according to monocyte levels to make crucial clinical decisions and shorten LOS.

CLINICAL TRIAL

Not applicable.

The association between the triglyceride‒glucose index and short-term mortality in ICU patients with sepsis-associated acute kidney injury

BACKGROUND

The triglyceride-glucose (TyG) index has emerged as a novel marker for insulin resistance and is commonly observed in patients suffering from sepsis-associated acute kidney injury (SA-AKI). This study explored the correlation between the TyG index and short-term all-cause mortality among SA-AKI patients.

METHODS

We performed a retrospective analysis of ICU patients with SA-AKI using data from the MIMIC-IV database. The primary outcomes were 28-day and 90-day all-cause mortality. Multivariate Cox proportional hazards regression, restricted cubic spline (RCS) models, and Kaplan‒Meier (K‒M) survival analyses were used to examine the associations between the TyG index and mortality. Subgroup and sensitivity analyses were conducted to ensure the robustness of the findings.

RESULTS

The study included 4971 SA-AKI patients, with 2873 males (57.8%), an average age of 65.4 years (± 15.8), and an average TyG index of 9.10 (± 0.70). RCS analysis revealed a U-shaped relationship between the TyG index and mortality. When the TyG index was below 9.04, the risk of mortality at both 28 days and 90 days was reduced (adjusted HRs of 0.695, 95% CI: 0.542-0.890 and 0.691, 95% CI: 0.557-0.858, respectively). In contrast, values above 9.04 were associated with increased mortality, though the relationship was not statistically significant (adjusted HRs of 1.026, 95% CI: 0.855-1.231 and 1.012, 95% CI: 0.863-1.188, respectively). K‒M analysis revealed higher mortality rates for patients with either high (T3) or low (T1) TyG indices than for those with moderate (T2) TyG indices. Sensitivity analyses confirmed these associations even after excluding patients with diabetes, cerebrovascular diseases, or ICU stays of less than 2 days.

CONCLUSION

The TyG index is significantly and nonlinearly associated with short-term all-cause mortality in SA-AKI patients; however, establishing a causal relationship between the two requires validation through larger prospective studies.

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).

Associations of estimated glucose disposal rate with frailty progression: results from two prospective cohorts

BACKGROUND

Frailty is a common geriatric syndrome associated with many adverse health outcomes. Identifying the risk factors of frailty is crucial and the insulin resistance (IR) is considered as a potential target. The estimated glucose disposal rate (eGDR) is a simple and reliable surrogate marker of IR. Associations of eGDR with frailty have not been explored. This study aimed to investigate the associations of eGDR with frailty progression.

METHODS

We used data from two prospective cohorts of the China Health and Retirement Longitudinal Study (CHARLS) and Health and Retirement Study (HRS). The eGDR was calculated as follows: eGDR (mg/kg/min) = 21.158 - (0.09×waist circumference) - (3.407×hypertension) - (0.551×glycosylated hemoglobin A1c) [waist circumference (cm), hypertension (yes = 1/no = 0), and glycosylated hemoglobin A1c (%)]. Participants were divided into three categories by tertiles of eGDR. Frailty index (FI) was calculated every two years and used to assess the degree of frailty which ranged from 0 to 100. Frailty progression was assessed by repeated measurements of FI during follow-up. Linear mixed-effect models were used to analyze the associations of eGDR with frailty progression.

RESULTS

8872 participants from CHARLS (mean age: 58.9 years, female: 53.3%) and 5864 participants from HRS (mean age: 67.0 years, female: 59.0%) were included. The median follow-up periods were 7.0 years in the CHARLS and 12.8 years in the HRS, respectively. Compared to participants with lower tertile (T1) of eGDR, those with upper tertile (T3) of eGDR showed decelerated FI progression (CHARLS, β: -0.294, 95%CI -0.390 to -0.198, P < 0.001; HRS, β: -0.378, 95%CI -0.474 to -0.281, P < 0.001). Continuous eGDR was also associated with FI progression for significant deceleration in FI progression with per 1 SD increase in eGDR (CHARLS, β: -0.142, 95%CI -0.181 to -0.103, P < 0.001; HRS, β: -0.170, 95%CI -0.209 to -0.130, P < 0.001). These associations were still observed after excluding baseline frail participants. Furthermore, the associations of eGDR with FI progression were consistent among participants with and without diabetes.

CONCLUSION

Regardless of diabetes or not, a higher level of eGDR was associated with the decelerated frailty progression. Our findings highlight the role of eGDR in frailty progression and recommend taking effective interventions to improve eGDR for preventing frailty progression.

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.

Role of Optic Nerve Sheath Diameter on Mortality Prediction in Patients Admitted to the Intensive Care Unit from the Emergency Department

Background/Objectives: Cerebrovascular events (CVEs) are a leading cause of intensive care unit (ICU) admissions from the emergency department, often associated with high morbidity and mortality rates. Identifying reliable, non-invasive predictors of mortality in these patients is critical for improving prognostic accuracy and guiding therapeutic strategies. This retrospective cohort study evaluates the predictive value of the optic nerve sheath diameter (ONSD), measured using magnetic resonance imaging (MRI), in determining mortality among ICU patients with CVEs. Methods: This single-center, retrospective observational study included 102 patients diagnosed with CVEs and admitted to the ICU at Gaziantep City Hospital between October 2023 and March 2024. This study adhered to the Declaration of Helsinki. Ethics approval was obtained from Gaziantep Islam Science and Technology University (Decision No. 394.36.08), and the requirement for informed consent was waived due to the retrospective design. The sample size was determined using G-Power 3.1.9.4. Results: A statistically significant positive correlation was observed between the ONSD and mortality (p = 0.002). Patients with higher ONSD values demonstrated an increased mortality risk, underscoring the potential prognostic value of ONSD measurements in this population. Conclusions: MRI-based ONSD measurement offers a non-invasive method for predicting mortality in ICU patients with CVEs. Its integration into routine diagnostic protocols could enhance clinical decision-making and patient outcomes. Further multicenter studies are warranted to validate these findings and standardize ONSD measurement techniques.

Association Between Triglyceride-Glucose Related Index and Endometriosis Varies According to Educational Level

BACKGROUND

The association between the triglyceride-glucose (TyG) level, its obesity-related derivatives, and the occurrence of endometriosis (EMS) remains ambiguous, particularly in individuals with higher levels of education. This study sought to explore the relationship between TyG, its obesity-related derivatives, and EMS across various educational backgrounds.

METHODS

This study utilized a substantial dataset obtained from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2006. To explore the relationship between TyG, its obesity-related derivatives, and EMS, we employed a variety of analytical methods, including multivariable logistic regression models, smooth curve fitting, threshold effect analysis, and subgroup analysis, which were applied to participants with varying educational levels.

RESULTS

Among the 2347 participants, 203 (8.65%) were diagnosed with EMS. In the overall population, only the TyG, TyG-waist-to-height ratio (TyG-WHtR), and TyG-waist circumference (TyG-WC) variables demonstrated a positive association with EMS. However, within the group with high educational attainment, TyG, TyG-WHtR, TyG-WC, and TyG-body mass index (TyG-BMI) all exhibited positive correlations with EMS. These associations remained robust after adjustment for multiple potential confounding variables. The subgroup analysis demonstrated that these associations were consistent across different subgroups (p > 0.05). Furthermore, both linear and nonlinear relationships were observed between TyG and its obesity-related derivatives and EMS, as evidenced by the smooth curve fittings and threshold effect analyses. In contrast, no significant associations were identified in the group with lower levels of education.

CONCLUSIONS

Our study suggests that there is variation in the association between TyG and its obesity-related derivatives and EMS across different educational levels, warranting further investigation. In individuals with higher education, elevated levels of TyG and its obesity-related derivatives were associated with a higher prevalence of EMS. Conversely, this correlation was not observed among those with lower educational levels.

Trajectories of systemic immune inflammation index and mortality risk in patients with moderate-to-severe traumatic brain injury: a retrospective cohort study

Background

Some studies have shown a strong link between the central nervous system and peripheral immune system, but the prognostic implications of dynamic peripheral immune-inflammatory responses in patients with traumatic brain injury (TBI) remain unclear. This study aimed to determine the dynamic trajectory patterns of the Systemic Immune Inflammation Index (SII) in patients with TBI and assess its association with all-cause hospital mortality.

Methods

This retrospective cohort study utilized a large public database of patients with TBI sourced from the eICU Collaborative Research Database (eICU-CRD). Group-Based Trajectory Modeling (GBTM) was used to analyze daily SII trajectories during the initial 0-7 days of hospitalization. Logistic regression was employed to assess the relationship between different SII trajectory groups and hospital mortality. Receiver Operating Characteristic (ROC) curves were generated based on the logistic regression model.

Results

A total of 312 patients were included in this study, 52 of whom died during hospitalization. Using GBTM, three distinct SII trajectories were identified: Group 1 (low-level, rapid decline; 18.90%), Group 2 (moderate-level, slow decline; 60.20%), and Group 3 (sustained high-level; 20.80%). Compared to patients in Group 1, those in Groups 2 and 3 had a higher risk of all-cause hospital mortality (odds ratio [OR] 4.09; 95% confidence interval [CI] 1.21, 19.75) and (OR 5.84; 95% CI 1.52, 30.67), respectively. ROC analysis revealed an area under the curve (AUC) of 0.838, sensitivity: 75.0%, and specificity: 83.8% for mortality in this cohort.

Conclusion

This study identified three distinct SII trajectories, suggesting that post-TBI SII trajectories are heterogeneous patterns associated with mortality. The sustained high-level SII trajectory may serve as a marker of disease deterioration, highlighting the need for targeted interventions. Describing the evolution of SII through GBTM and its correlation with clinical outcomes can enhance our understanding of the link between neuroinflammation and the peripheral immune system.

The association between TyG index and cardiovascular mortality is modified by antidiabetic or lipid-lowering agent: a prospective cohort study

BACKGROUND

The triglyceride-glucose (TyG) index is recognized as an alternative measure of insulin resistance (IR) and has been linked to the risks of cardiovascular disease (CVD) and mortality. This study aimed to evaluate whether the association between the TyG index and CVD mortality is influenced by the use of antidiabetic and hypolipidemic agents, given their potential modifying effects on the TyG index.

METHODS

Participants from the National Health and Nutrition Examination Survey (1999-2018) were included in the study. Mortality outcomes were tracked through linkage with National Death Index records until December 31, 2019. Data on the use of antidiabetic and hypolipidemic medications (including prescribed insulin, diabetic pills, and cholesterol-lowering agents) were self-reported by participants.

RESULTS

A total of 5,046 adults (representing 42,753,806 individuals, weighted mean age 61.08 years [SE: 0.24]; 49.35% female) were analyzed. The TyG index was significantly associated with all-cause and CVD mortality, and these associations were modified by the use of antidiabetic and hypolipidemic agents (p < 0.01). Significant interactions were observed between the TyG index and the use of these agents for mortality outcomes after full adjustments (p-value for interaction < 0.05). Exposure-effect analysis revealed a U-shaped relationship between TyG index levels and the risks of all-cause and CVD mortality in participants using these agents, while a linear positive relationship was observed in participants not using these agents.

CONCLUSIONS

The use of antidiabetic and hypolipidemic agents modify the association between the TyG index and all-cause and CVD mortality. These findings suggest that future studies on the TyG index and its relationship with CVD and mortality should account for the modifying effects of these agents.

Association between the triglyceride-glucose index and the risk of acute kidney injury in critically ill patients with acute pancreatitis: a retrospective study

BACKGROUND

The triglyceride-glucose (TyG) index is increasingly recognized for its ability to predict cardiovascular and metabolic risks. This study investigated the correlation between the TyG index and the risk of acute kidney injury(AKI) in critical ill patients with acute pancreatitis(AP).

METHODS

The Medical Information Mart for Intensive Care IV database was retrospectively searched to identify AP patients hospitalized in the intensive care unit. The primary outcome measure was the incidence of AKI. The secondary endpoint was in-hospital mortality and the rate of renal replacement therapy(RRT) use. Cox regression analysis and restricted cubic spline were used to analyze TyG index association with AKI risk. Kaplan-Meier survival analysis was performed to assess the incidence of endpoints in the different groups.

RESULTS

A total of 848 patients were enrolled. The incidence of AKI was 61.56%.The in-hospital mortality was 11.69%. Kaplan-Meier analysis showed that the TyG index ≥ 8.78 group has a high incidence of AKI and high risk of requiring RRT (P < 0.001). Multivariable Cox regression analysis showed whether TyG index was a continuous variable (HR, 1.65 [95% CI 1.10-2.48], P = 0.015) or a categorical variable (HR, 1.72 [95% CI 1.09-2.79], P = 0.028), and the TyG index was independently associated with the risk of AKI in AP patients. The restricted cubic splines model illustrated the linear relationship between higher TyG index and increased risk of AKI in this specific patient population.

CONCLUSIONS

High TyG index is an independent risk factor for AKI in critical ill patients with AP. Assessing the TyG index may be beneficial for early stratification and interventions to improve prognosis.

Prognostic nutritional index as a predictor of mortality in acute ischemic stroke

OBJECTIVE

Nutritional and immune status have been recognized as important factors influencing the prognosis of acute ischemic stroke. This study aims to evaluate the prognostic value of the Prognostic Nutritional Index (PNI) in predicting 30-day mortality in patients with acute ischemic stroke.

METHODS

A retrospective cohort study was conducted in a tertiary care hospital emergency department. Patients diagnosed with acute ischemic stroke between January 1, 2019, and January 1, 2024, were included. PNI was calculated using serum albumin levels and total lymphocyte count. Data on demographics, clinical parameters, laboratory results, and 30-day mortality were collected from electronic medical records and patient follow-up via phone calls. Appropriate statistical tests were applied based on the data distribution, and p-values < 0.05 were considered statistically significant.

RESULTS

A total of 169 patients were included in the study, with a mean age of 74.2 ± 10.5 years, and 55 % were male. Of these patients, 25 (14.8 %) did not survive within the 30-day follow-up period. PNI was significantly lower in deceased patients compared to survivors (p < 0.001). The area under the receiver operating characteristic (AUROC) curve was 0.831, indicating good predictive accuracy for 30-day mortality. The optimal PNI cut-off of 37.21 demonstrated a sensitivity of 72.0 % and a specificity of 81.2 %.

CONCLUSION

The PNI is a reliable predictor of 30-day mortality in acute ischemic stroke patients. Lower PNI values were associated with higher mortality, highlighting the importance of nutritional and immune status in stroke outcomes. PNI could be used in clinical practice to help identify high-risk patients and inform more appropriate treatment decisions.

Association of triglyceride-glucose related indices with mortality among individuals with MASLD combined with prediabetes or diabetes

BACKGROUND

The prognostic significance of triglyceride-glucose (TyG)-related indices in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) combined with prediabetes or diabetes is not yet fully understood. In this study, we explored their predictive value for mortality in this specific population.

METHODS

Patients with MASLD were identified from the National Health and Nutrition Examination Survey (NHANES III) database. TyG and its related parameters [TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), TyG-weight-adjusted waist index (TyG-WWI), and TyG-body mass index (TyG-BMI), ] were calculated. To examine the association between TyG-related indices and mortality risk, Cox regression models were utilized. Furthermore, we employed restricted cubic spline (RCS) analysis to investigate potential dose-response relationships. The predictive ability of the TyG indices for mortality was assessed by analyzing the time-dependent area under the curve (AUC).

RESULTS

In the cohort of patients with prediabetes or diabetes, 46.5% were diagnosed with MASLD. Over a median follow-up of 25.4 years, 1,163 individuals (53.9%) died, with 329 (15.3%) deaths attributed to cardiovascular causes and 78 (3.6%) to diabetes. Multivariate Cox regression models showed that TyG, TyG-BMI, TyG-WHtR, TyG-WWI, and TyG-WC were associated with all-cause and cardiovascular/diabetes-specific mortality. Furthermore, RCS analysis revealed a positive linear relationship between the TyG and TyG-WWI indices and all-cause mortality (p for nonlinear = 0.920; p = 0.525, respectively). In contrast, the TyG-WC, TyG-BMI, and TyG-WHtR indices exhibited a positive nonlinear association with all-cause mortality (p for nonlinear = 0.001; = 0.003; = 0.007, respectively). Time-dependent AUC curves demonstrated that the TyG-WWI index was the most robust predictor of both all-cause and cardiovascular mortality.

CONCLUSIONS

Elevated levels of TyG, TyG-BMI, TyG-WHtR, TyG-WWI, and TyG-WC indices were associated with a poorer prognosis in MASLD patients with prediabetes or diabetes, with TyG-WWI being the strongest predictor.

Predictive Analysis of the Mortality Rate of Patients with Heart Failure Complicated by Acute Kidney Failure Based on the Fluid Balance: A Retrospective Study Using the MIMIC-IV Database

BACKGROUND

Heart failure (HF) is a global health issue, and its complication with acute kidney failure (AKF) increases the risk of mortality. This study aimed to investigate the predictive value of fluid balance for mortality in patients with HF complicated by AKF. A retrospective analysis was performed using the MIMIC-IV database to evaluate the relationship between fluid balance and mortality in patients with HF complicated by AKF.

MATERIAL AND METHODS

Adult patients with HF and AKF and who were listed in the MIMIC-IV database between 2008 and 2019 were included. The patients were divided into survival and non-survival groups. The primary outcome measure was fluid intake and output in the first three days in the intensive care unit (ICU). The main outcome being in-ICU mortality and the secondary outcome being 28‑day mortality after ICU admission. A multivariable Cox proportional hazards model was used to assess the relationship between fluid balance and the risk of death, after adjusting for potential confounding factors.

RESULTS

A total of 1433 eligible patients were included. The study found that compared to the death group, patients in the survival group maintained lower positive balance on day 1 (453.51 ml vs 1813.66 ml), negative balance on day 2 (-246.75 ml vs 646.00 ml), and negative balance on day 3 (-350.21 ml vs 312.92 ml). Additionally, fluid balance on the first day predicted ICU mortality rate (AUC 0.658, p<0.01), on the second day it predicted ICU mortality rate (AUC 0.654, p<0.01), and on the third day it also predicted ICU mortality rate (AUC 0.634, p<0.01).

CONCLUSION

Positive fluid balance in patients with HF and AKF is independently associated with higher in-hospital mortality. Monitoring and managing fluid balance may provide clinicians with an important tool to improve patient outcomes.

Association between triglyceride-glucose-body mass index and risk of aortic stenosis progression in patients with non-severe aortic stenosis: a retrospective cohort study

BACKGROUND

Triglyceride-glucose-BMI (TyG-BMI) index is a surrogate marker of insulin resistance and an important predictor of cardiovascular disease. However, the predictive value of TyG-BMI index in the progression of non-severe aortic stenosis (AS) is still unclear.

METHODS

The present retrospective observational study was conducted using patient data from Aortic valve diseases RISk facTOr assessmenT andprognosis modeL construction (ARISTOTLE). A total of 190 patients were recruited from one-center. Patients were divided into two groups according to the cut-off value of TyG-BMI index (Ln[triglycerides (mg/dL)* glucose (mg/dL)/2]*BMI). Cox regression and restricted subgroup analysis were used to evaluate the association of TyG-BMI index and progression of non-severe AS.

RESULTS

A total of 190 patients (mean age 72.52 ± 11.97 years, 51.58% male) were included in the study. During a median follow-up period of 27.48 months, 44 participants experienced disease progression. The cut-off of the TyG-BMI index is 239. After fully adjusting for confounding factors, high TyG-BMI index group was associated with a 2.219-fold higher risk of aortic stenosis progression (HR 2.219, 95%CI 1.086-4.537, p = 0.029).

CONCLUSION

TyG-BMI index was significantly associated with a higher risk of progression to non-severe AS. TyG-BMI index, as an effective alternative indicator of IR, can identify people at high risk of AS progression at an early stage of the disease, thereby improving the prognosis and reducing the socio-economic burden.

Association of the triglyceride glucose index with all cause and CVD mortality in the adults with diabetes aged < 65 years without cardiovascular disease

Although the triglyceride-glucose (TyG) index has been established as a valuable predictor for cardiovascular disease (CVD) and cardiovascular mortality, there is limited research exploring its association with all-cause or CVD mortality specifically in adults with diabetes aged < 65 years without cardiovascular disease. This study aimed to investigate the relationship between the TyG index and both all-cause and CVD mortality in this population within the United States. Our study recruited 1778 adults with diabetes aged < 65 years without cardiovascular disease from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. Mortality outcomes were determined by linking to National Death Index (NDI) records up to December 31, 2019. Cox regression modeling was employed to examine the association between the TyG index and mortality in this population. The nonlinear relationship between the TyG index and mortality was assessed using restricted cubic splines (RCS). Additionally, subgroup analyses and interaction tests were conducted to explore potential effect modifiers. A total of 1788 participants were included in the final cohort, with an average age of 49.61 ± 0.32 years. During a median follow-up of 7.92 years, the occurrence of 150 all-cause deaths and 33 CVD-related deaths were recorded. To investigate the independent association between the TyG index and the risks of all-cause and CVD mortality, three Cox regression models were developed. In Model 1, a significant positive association was observed between the TyG index and the risk of all-cause mortality (HR 1.38, 95% CI 1.09-1.74). This association persisted in the minimally adjusted model (HR 1.44, 95% CI 1.13-1.83), which was adjusted for age, gender and race. Even after full adjustment, this positive association remained significant (HR 1.91, 95% CI 1.36-2.70). We also found that the relationship between the TyG index and all-cause mortality was linear. Subgroup analyses revealed no significant interactions between the TyG index and the stratification variables. However, we did not observe a significant association between the TyG index and CVD mortality in this population. Our results suggested that a significantly positive association between the TyG index and all-cause mortality. The positive association between the TyG index and all-cause mortality was linear. We did not observe a significant association between the TyG index and CVD mortality.

Association of different insulin resistance surrogates with all-cause and cardiovascular mortality among the population with cardiometabolic multimorbidity

BACKGROUND

The coexistence of cardiometabolic diseases (CMDs), defined as cardiometabolic multimorbidity (CMM), has been shown to significantly elevate mortality risk. Insulin resistance (IR) is one of the main contributing factors to the pathogenesis of CMM. Although several surrogates for IR are employed in clinical evaluations, their relationship with mortality in individuals with CMM remains unclear. This study aimed to investigate the associations between various IR surrogates and mortality in individuals with CMM, and to evaluate their prognostic value.

METHODS

This study enrolled 1093 patients diagnosed with CMM. We developed five surrogate markers to assess IR levels: triglyceride-glucose (TyG) index, TyG-waist circumference (TyG-WC), TyG-waist height ratio (TyG-WHtR), homeostatic model assessment of insulin resistance (HOMA-IR), and metabolic score for insulin resistance (METS-IR). To investigate the associations between different IR surrogates and both all-cause and cardiovascular mortality, multivariable Cox proportional hazards models were applied. We employed restricted cubic splines to examine non-linear associations, and Cox models were developed on either side of the inflection point for additional investigation. Meanwhile, the predictive values of five IR surrogates were further assessed.

RESULTS

Of the 477 all-cause deaths that occurred during a median follow-up of 5.8 years, 197 were related to cardiovascular disease. Among five surrogate markers of IR, the TyG index was the only one that significantly correlates with both all-cause and cardiovascular mortality. The threshold value for both types of mortality was 8.85. A TyG index beneath the inflection point exhibits an inverse correlation with cardiovascular mortality (HR 0.483; 95% CI = 0.281-0.831) and all-cause mortality (HR 0.519; 95% CI = 0.368-0.732). On the other hand, when the TyG index surpassed the inflection point, it demonstrated a positive correlation with cardiovascular mortality (HR 1.413; 95% CI = 1.075-1.857) and all-cause mortality (HR 1.279; 95% CI = 1.070-1.529). Based on the analysis of receiver operating characteristics, the TyG index has been recognized as a dependable predictor of survival outcomes.

CONCLUSIONS

This study emphasizes the prognostic significance of IR surrogates, particularly the TyG index, in predicting mortality among individuals with CMM. The TyG index constitutes a crucial element in the development of management and intervention strategies for these patients.

Association of TyG index with mortality at 28 days in sepsis patients in intensive care from MIMIC IV database

The relationship between the triglyceride‒glucose (TyG) index and the clinical prognosis of septic patients in intensive care units (ICUs) remains unclear. This study aimed to explore the correlation between the TyG index and 28-day all-cause mortality in septic patients. A retrospective observational cohort study was conducted, including 8955 septic patients from the MIMIC IV 2.2 database. The primary outcome was 28-day all-cause mortality. Multivariate logistic regression analysis and restricted cubic spline regression analysis were used to assess the relationship between the TyG index and 28-day all-cause mortality in septic patients. Subgroup analyses and sensitivity analyses were performed to further validate the robustness of the results. A total of 8955 septic patients were included, 5219 (58.3%) of whom were male, with a mean age of 66.3 (15.8) years and an average TyG index of 9.08 (0.70) and the number of deaths within 28 days was 1639 (18.3%). The RCS curve demonstrated a U-shaped relationship between the TyG index and 28-day all-cause mortality (nonlinear P value = 0.0003). The risk of 28-day all-cause mortality was negatively associated with the TyG index until it decreased to 9.03 (adjusted odds ratio [OR] 0.727, 95% confidence interval [CI] 0.577-0.915). However, when the TyG index exceeded 9.03, the odds ratio for 28-day all-cause mortality significantly increased (adjusted OR 1.185, 95% CI 1.001-1.404). These findings were consistent across subgroups and various sensitivity analyses. Our study revealed a nonlinear U-shaped relationship between the TyG index and 28-day all-cause mortality, with a critical point at a TyG index of 9.03. Our results suggest that the TyG index may be a novel and important factor for the short-term clinical prognosis of critically ill septic patients.

Triglyceride-glucose index as a biomarker to differentiate stroke etiologic subtypes: a hospital-based cross-sectional study

BACKGROUND

Accurate distinction between stroke etiologic subtypes is critical for physicians to provide tailored treatment. The triglyceride-glucose (TyG) index, a marker of insulin resistance, has been associated with stroke risk but its role in distinguishing stroke etiologic subtypes remains unclear. We aimed to assess the TyG index's ability to differentiate cardioembolic (CE) from non-cardioembolic (NCE) strokes.

METHODS

We studied 320 consecutive stroke patients in a cross-sectional analysis. Binary logistic regression was performed to analyze the association between the TyG index and the studied stroke subtypes. Receiver operating characteristic (ROC) curve analysis identified the optimal TyG index cutoff for CE vs. NCE differentiation.

RESULTS

TyG index correlated independently with NCE subtype (OR = 2.38; 95% CI = 1.52-3.73; p < 0.001). Logistic regression revealed increasing NCE stroke risk with higher TyG index quartiles. The ROC curve yielded an AUC of 0.636 (95% CI = 0.565-0.707; p < 0.001), with a cutoff of 8.8 (sensitivity = 68.8%, specificity = 57%).

CONCLUSION

The TyG index can be a useful biomarker in the differentiation between CE and NCE strokes.

Association of reverse dipping blood pressure with mortality among critically ill patients with ischemic stroke

Reverse dipping blood pressure, generally regarded as a pathological condition, is frequently observed in patients with acute stroke. We aimed to assess the association of reverse dipping blood pressure with in-hospital mortality among critically ill patients with ischemic stroke. This is a retrospective study of patients in the Medical Information Mart for Intensive Care IV database with ischemic stroke requiring intensive care unit admission. Diurnal (9:00-21:00) and nocturnal (1:00-6:00) mean arterial pressures (MAPs) were collected. Reverse dipping was defined as having an average nocturnal MAP higher than the average diurnal MAP. Multivariable binary logistic regression analysis was used to assess the association of reverse dipping with in-hospital mortality. A total of 2080 patients (median age, 73 years; 50.3% female) were enrolled, among which 681 patients (32.7%) had reverse dipping. Patients with reverse dipping blood pressure had a higher in-hospital mortality compared to those without (19.8% vs. 11.4%, p < 0.001). After adjusting for potential confounders, reverse dipping was associated with a higher likelihood of in-hospital mortality (adjusted OR, 1.59; 95% CI 1.21-2.11; p = 0.001). Reverse dipping blood pressure was associated with a higher mortality rate among critically ill patients with ischemic stroke. The circadian rhythm of blood pressure should warrant more attention in cerebrovascular neurocritical care.

Differential impact of TyG and TyG-BMI indices on short- and long-term mortality in critically ill ischemic stroke patients

BACKGROUND

Ischemic stroke is a major contributor to global morbidity and mortality, particularly in critically ill patients in intensive care units (ICUs). While advances in stroke management have improved outcomes, predicting mortality remains challenging due to the involvement of complex metabolic and cardiovascular factors. The triglyceride-glucose (TyG) index, a marker for insulin resistance, has gained attention for its potential to predict adverse outcomes in stroke patients. Furthermore, the TyG-BMI index, which combines TyG with body mass index (BMI), may offer a more comprehensive measure by accounting for obesity-related metabolic burden. However, the comparative impact of these indices on short- and long-term mortality among critically ill ischemic stroke patients remains unclear.

METHODS

This retrospective cohort study analyzed data from the Medical Information Mart for Intensive Care IV (MIMIC-IV 3.0) database, including 1,334 critically ill ischemic stroke patients. The patients were divided into four groups based on TyG and TyG-BMI quartiles, respectively. Cox proportional hazards models were employed to assess the association of these indices with 30-day, 90-day, 180-day, and 1-year all-cause mortality (ACM). Kaplan-Meier survival analysis was used to compare survival rates across different index levels. We utilized restricted cubic splines (RCS) to examine the association between the TyG, TyG-BMI index and the specified outcomes. Furthermore, TyG and TyG-BMI index were utilized to establish logistic regression models for mortality across different time periods, and corresponding Receiver Operating Characteristic (ROC) curves were generated.

RESULTS

Kaplan-Meier survival analysis show that Higher TyG levels were associated with significantly increased mortality risk at all time points, with patients in the highest TyG quartile exhibiting the greatest risk. Conversely, patients having a lower TyG-BMI level faced a heightened risk of long-term ACM. The RCS analysis results demonstrated that the TyG index did not exhibit a statistically significant nonlinear relationship with mortality across all time points. However, a significant nonlinear relationship was observed between the TyG index and long-term mortality. From the ROC curve, it can be observed that TyG performs better in predicting short-term mortality. Conversely, TyG-BMI demonstrates superior performance in predicting long-term mortality. The analysis revealed that while the TyG index alone is a strong predictor of mortality, the TyG-BMI index enhances the ability to predict long-term outcomes.

CONCLUSION

This finding suggests both the TyG and TyG-BMI indices serve as valuable predictors of mortality in critically ill ischemic stroke patients. However, significant differences were observed across the various follow-up periods. Based on the distinct characteristics of these two indicators, future research should focus on the selective integration of TyG and TyG-BMI indices into clinical risk assessment models, tailored to the metabolic profiles of ischemic stroke patients in the ICU. This approach could enhance the precision of mortality risk stratification and optimize patient management strategies.

Adjustment of the ACEF score by the triglyceride glucose index improves the prediction of clinical outcomes in patients undergoing percutaneous coronary intervention

BACKGROUND

The ACEF score (age, creatinine, and left ventricular ejection fraction) and the triglyceride-glucose (TyG) index have been identified as robust risk prediction models for adverse outcomes post-percutaneous coronary intervention (PCI) in coronary atherosclerotic heart disease (CHD) patients. This study aimed to assess whether incorporating the TyG index enhances the predictive ability of the ACEF score and enhances risk stratification for CHD patients undergoing PCI.

METHODS

This observational cohort study enrolled 1248 patients diagnosed with CHD who underwent PCI at the Third People's Hospital of Chengdu, China, between May 2018 and December 2022. Receiver operating characteristic (ROC) curves were employed to establish the optimal cutoff values for the TyG index and ACEF score. The primary endpoint event was defined as major adverse cardiac and cerebrovascular events (MACCEs). Cumulative survival curves were plotted using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were conducted to identify predictors of MACCEs. The predictive ability of the ACEF score and the TyG index was assessed using the area under the ROC curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

RESULTS

Over a median follow-up period of 30.60 months, 214 patients experienced MACCEs. Kaplan-Meier survival analysis demonstrated a significant association between elevated ACEF score (> 1.27) and TyG index levels (> 8.82) with a heightened incidence of MACCEs (HR = 2.018, 95%CI 1.593-2.789; HR = 2.057, 95%CI 1.572-2.691; Log-Rank test, both P < 0.001). Multivariable Cox regression analysis revealed that even after adjusting for multiple confounders, both the ACEF score and TyG index remained as predictors of MACCEs (HR = 1.702, 95%CI 1.210-2.394, P = 0.002; HR = 1.575, 95%CI 1.296-1.916, P < 0.001). Additionally, the addition of the ACEF score and TyG index into the conventional risk model significantly improved the ability to predict MACCEs, as evidenced by the increase in the C-statistic value from 0.664 to 0.703, along with notable improvements in continuous NRI (0.391), categorical NRI (0.107), and IDI (0.033) (all P < 0.001).

CONCLUSION

The combination of the TyG index and the ACEF score enhances the predictive ability for long-term MACCEs in patients with CHD undergoing PCI.

Exploring the prognostic impact of triglyceride-glucose index in critically ill patients with first-ever stroke: insights from traditional methods and machine learning-based mortality prediction

BACKGROUND

The incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes.

METHODS

We included first-ever stroke patients from the eICU Collaborative Research Database in 2014-2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital's ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score.

RESULTS

The primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0-68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0-77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38-2.66) and hospital (HR 1.69, 95% CI 1.32-2.16) all-cause mortality, compared with low TyG group (TyG < 9.265). TyG was also correlated with ICU length of stay (r = 0.077), hospital length of stay (r = 0.042), and Glasgow Coma Score (r = -0.132). TyG and other six features were used to construct ML models. The random forest model performed best in internal validation with AUC (0.900) and G-mean (0.443), and in external validation with AUC (0.776) and G-mean (0.399).

CONCLUSION

TyG (optimal cut-off: 9.265) was identified as an independent risk factor for ICU and hospital all-cause mortality in first-ever strokes. The ML model incorporating TyG demonstrated strong predictive performance. This emphasises the importance of insulin resistance (with TyG as a surrogate measure) in the prognostic assessment and early risk stratification of first-time stroke patients.

Relationships among Helicobacter pylori seropositivity, the triglyceride-glucose index, and cardiovascular disease: a cohort study using the NHANES database

BACKGROUND

Helicobacter pylori (H. pylori), a widely prevalent pathogen that can be cured through relatively simple medical methods, is thought to be potentially associated with the risk of cardiovascular diseases (CVD), although controversy remains. Currently, it is unclear whether the triglyceride-glucose index (TGI), a classic indicator of insulin resistance, influences the relationship between H. pylori infection and CVD. The present work explored the relationships between H. pylori seropositivity, the TGI and CVD, and the potential effect of TGI in this association.

METHODS

In this cross-sectional and cohort study, data from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES (1999-2000) were used. The effects of the TGI, H. pylori seropositivity, and their interaction on the risk of CVD were assessed using logistic regression models. The hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality (ACM) were calculated using the Cox proportional hazards model. Restricted cubic spline (RCS) curves were employed to investigate potential non-linear or linear relationships among the TGI, H. pylori seropositivity, occurrence of CVD, and ACM. Mediation analyses were employed to assess the potential effects of H. pylori seropositivity and TGI on the risk of CVD and mortality.

RESULTS

Of the 9,399 participants, 4,488 (47.75%) were H. pylori-immunoglobulin G (IgG)-positive, and 3,934 (41.86%) were diagnosed with CVD. In the general population, participants with a TGI ≥ 75th percentile who were positive for H. pylori-IgG antibody had the highest risk of developing CVD (odds ratio = 1.487; 95% CI: 1.088-2.033). Among patients with CVD, those with a TGI ≥ 75th percentile & positive for H. pylori-IgG antibody were at a higher ACM risk (HR = 1.227; 95% CI: 1.009-1.491). H. pylori exhibited a significant mediating effect on CVD occurrence (Pindir = 0.004) and mortality (Pindir = 0.004) via the TGI.

CONCLUSIONS

H. pylori seropositivity may indirectly elevate the risk of CVD and mortality via the TGI. Combining the patient's H. pylori serological status with their TGI could enhance the predictive ability for CVD occurrence and related mortality. Therefore, the clinical practice of screening for and eradicating H. pylori in CVD patients may be anticipated.

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.

L-shaped association between triglyceride-glucose body mass index and short-term mortality in ICU patients with sepsis-associated acute kidney injury

Background

Sepsis is a systemic inflammatory response syndrome, with sepsis-associated acute kidney injury (SA-AKI) being a common complication. Insulin resistance (IR) is closely related to the stress response, inflammatory response, and severity of critical illness. The triglyceride-glucose body mass index (TyG-BMI) is a valuable tool for assessing IR. However, the relationships between TyG-BMI and clinical outcomes in patients with SA-AKI remain unclear.

Methods

We conducted a retrospective analysis of ICU patients with SA-AKI using data from the MIMIC-IV database. The Boruta algorithm was employed to select significant features for predicting short-term mortality in SA-AKI patients. Multivariate Cox proportional hazards regression, sensitivity analysis, restricted cubic spline (RCS) models, and Kaplan-Meier (K-M) survival analysis were used to assess the relationship between TyG-BMI and short-term mortality in SA-AKI patients. Subgroup analyses considered the effects of age, sex, ethnicity, comorbidities and septic shock.

Results

This study included 3,349 patients, with males accounting for 60.5% of the patients. The Boruta analysis identified the TyG-BMI as an important clinical feature. Higher TyG-BMI values were significantly associated with reduced short-term mortality rates (28, 90, and 180 days) in patients with SA-AKI; for each standard deviation increase in TyG-BMI, the risk of all-cause death decreased by 0.2% (p < 0.0001). Kaplan-Meier analysis demonstrated that patients with high TyG-BMIs had significantly lower mortality rates than did those with low TyG-BMIs. The RCS model revealed an L-shaped nonlinear relationship between the TyG-BMI and mortality. Sensitivity analyses indicated that the association remained significant even after excluding patients with myocardial infarction, congestive heart failure, or those who were hospitalized in the ICU for less than 2 days. Subgroup analyses revealed a significant interaction effect on short-term mortality in CRRT patients (p < 0.05).

Conclusion

The relationship between the TyG-BMI and short-term mortality in ICU patients with SA-AKI is significant, indicating its potential value for early risk assessment and clinical intervention.

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.

Predictive value of triglyceride-glucose index for the occurrence of acute respiratory failure in asthmatic patients of MIMIC-IV database

This study aims to investigate the association between the triglyceride-glucose (TyG) index and the occurrence of acute respiratory failure in asthma patients. This retrospective observational cohort study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database. The primary outcome was the development of acute respiratory failure in asthma patients. Initially, the Boruta algorithm and SHapley Additive exPansions were applied to preliminarily determine the feature importance of the TyG index, and a risk prediction model was constructed to evaluate its predictive ability. Secondly, Logistic regression proportional hazards models were employed to assess the association between the TyG index and acute respiratory failure in asthma patients. Finally, subgroup analyses were conducted for sensitivity analyses to explore the robustness of the results. A total of 751 asthma patients were included in the study. When considering the TyG index as a continuous variable, logistic regression analysis revealed that in the unadjusted Model 1, the odds ratio (OR) was 2.381 (95% CI: 1.857-3.052; P < 0.001), in Model II, the OR was 2.456 (95% CI: 1.809-3.335; P < 0.001), and in the multivariable-adjusted model, the OR was 1.444 (95% CI: 1.029-2.028; P = 0.034). A consistent association was observed between the TyG index and the risk of acute respiratory failure in asthma patients. No significant interaction was found between the TyG index and various subgroups (P > 0.05). Furthermore, machine learning results indicated that an elevated TyG index was a significant feature predictive of respiratory failure in asthma patients. The baseline risk model achieved an AUC of 0.743 (95% CI: 0.679-0.808; P < 0.05), whereas the combination of the baseline risk model with the TyG index yielded an AUC of 0.757 (95% CI: 0.694-0.821; P < 0.05). The TyG index can serve as a predictive indicator for acute respiratory failure in asthma patients, albeit confirmation of these findings requires larger-scale prospective studies.

Acute hyperglycemia exacerbates neuroinflammation and cognitive impairment in sepsis-associated encephalopathy by mediating the ChREBP/HIF-1α pathway

OBJECTIVES

Delirium is a prominent symptom of sepsis-associated encephalopathy (SAE) and is highly prevalent in septic patients hospitalized in the intensive care unit, being closely connected with raised mortality rates. Acute hyperglycemia (AH) has been recognized as a separate risk factor for delirium and a worse prognosis in critically sick patients. Nevertheless, the exact contribution of AH to the advancement of SAE is still unknown.

METHODS

This research retrospectively evaluated the connection between blood glucose levels (BGLs) and the incidence of delirium and death rates in septic patients in the ICU of a tertiary comprehensive hospital. In addition, a septic rat model was induced through cecal ligation and puncture (CLP), after which continuous glucose infusion was promptly initiated via a central venous catheter post-surgery to evaluate the potential implications of AH on SAE. Next, septic rats were assigned to four groups based on target BGLs: high glucose group (HG, ≥ 300 mg/dL), moderate glucose group (MG, 200-300 mg/dL), normal glucose group (NG, < 200 mg/dL), and a high glucose insulin-treated group (HI, 200-300 mg/dL) receiving recombinant human insulin treatment (0.1 IU/kg/min). The sham group (SG) received an equivalent volume of saline infusion and denoted the NG group. The effects of AH on neuroinflammation and cognitive function in septic rats were evaluated using behavioral tests, histopathological examination, TUNEL staining, ELISA, and Western blot. The effects of glucose levels on microglial activation and glucose metabolism following lipopolysaccharide (LPS, 1 μg/mL) exposure were assessed using CCK8 assay, qRT-PCR, Western blot, and ELISA.

RESULTS

Our findings revealed that AH during sepsis was a separate risk factor for delirium and assisted in predicting delirium occurrence. AH raised the levels of systemic and central inflammatory cytokines in septic rats, promoting neuronal apoptosis, blood-brain barrier disruption, and cognitive impairment. In addition, both in vivo and in vitro, an elevated glucose challenge increased the ChREBP, HIF-1α, glycolytic enzymes, and inflammatory cytokines expressions in microglia after exposure to CLP or LPS.

CONCLUSIONS

These results collectively suggest that hyperglycemia can exacerbate neuroinflammation and delirium by enhancing microglial glycolysis under septic conditions, potentially mediated by upregulation of the ChREBP/HIF-1α signaling pathway.

Association between serum glucose potassium ratio and mortality in critically ill patients with intracerebral hemorrhage

The effect of serum glucose-to-potassium ratio (GPR) on cerebrovascular diseases has been previously validated. However, the value of the GPR in patients with severe intracerebral hemorrhage (ICH) requiring ICU admission remains unclear. This study aimed to investigate the association between the GPR and the clinical prognosis of critically ill patients with ICH. This study identified patients with severe ICH requiring ICU admission from the Medical Information Mart for Intensive Care (MIMIC-IV) database and divided them into quartiles based on GPR levels. Outcomes included 30-day, 90-day, and 1-year mortality rates. The association between the GPR and clinical outcomes in critically ill patients with ICH was elucidated using Cox proportional hazards regression analysis and restricted cubic splines. In total, 2018 patients (53.8% male), with a median age of 70 years, were enrolled in the study. The 30-day, 90-day, and 1-year mortality rates were 23.9%, 30.1%, and 38.4%, respectively. Per multivariate Cox proportional hazards analysis, an elevated GPR was significantly associated with all-cause mortality. After adjusting for age, sex, Charlson Comorbidity Index, white blood cell count, red blood cell count, platelet count, and Glasgow Coma Scale, patients with an elevated GPR had a higher 30-day mortality (hazard ratio [HR]: 1.32; 95% confidence interval [CI]: 1.22-1.42; P < 0.001), 90-day mortality (HR: 1.27; 95% CI: 1.18-1.37; P < 0.001) and 1-year mortality (HR: 1.22; 95% CI: 1.14-1.31; P < 0.001) when analyzed as a continuous variable. Furthermore, analysis using restricted cubic splines demonstrated a consistent and progressive escalation in the risk of all-cause mortality with an elevated GPR. The GPR was significantly associated with short- and long-term all-cause mortality in critically ill patients with ICH. This finding demonstrates that GPR may be useful in identifying patients with ICH at a high risk of all-cause mortality.

Triglyceride-glucose index-A novel metabolism disorder biomarker as a promising indicator for predicting postoperative 30-day infections in elderly patients undergoing gastrointestinal-related abdominal and pelvic surgery

BACKGROUND

The triglyceride-glucose index, a reliable surrogate biomarker of insulin resistance, has been reported to be associated with cardiovascular events and atherosclerosis. However, few studies have investigated the association of the triglyceride-glucose index with postoperative infections. This study aimed to study the clinical risk values of the preoperative triglyceride-glucose index in postoperative infection complications in elderly patients undergoing gastrointestinal-related abdominal and pelvic surgery.

METHODS

This retrospective cohort study included 3,225 older patients who underwent gastrointestinal-related abdominal and pelvic surgery between 2014 and 2019. The patients were divided into groups of triglyceride-glucose index ≤8.268 and triglyceride-glucose index >8.268 according to the optimal triglyceride-glucose index cut-off value. The outcome of interest was postoperative infections within 30 days after surgery. Primary and subgroup analyses were performed to confirm that preoperative triglyceride-glucose index qualifies as a reliable, independent risk indicator. Propensity score matching analysis was further applied to address covariates' potential residual confounding effect and test the robustness of the results.

RESULTS

In this study, the median age was 71 years (interquartile range, 67, 75 years), the proportion of male patients was 66.3%, and 1,058 (32.8%) were infected within 30 days after surgery. A triglyceride-glucose index >8.268 was associated with an increased risk of postoperative infections in multivariate regression analysis (odds ratio, 1.37; 95% confidence interval, 1.15-1.64; P < .001). The correlation between the triglyceride-glucose index and postoperative infections remained significantly robust (odds ratio, 1.52; 95% confidence interval, 1.21-1.92; P < .001) in the propensity score matching analysis.

CONCLUSIONS

The triglyceride-glucose index elevation determined by the optimal cutoff value of 8.268 was an independent risk factor for developing postoperative infections.

Predictive value of triglyceride glucose index in acute kidney injury in patients with severe traumatic brain injury

Background At present, the relationship between the Triglyceride-glucose index (TyG index) and Acute kidney injury (AKI) in traumatic brain injury patients in the Intensive Care Unit (ICU) is still unclear. Currently, the relationship between TyG index and AKI occurred within 7 days in the ICU is a highly researched and trending topic. Objective In this study, we conducted in-depth exploration of the relationship between the development of AKI in traumatic brain injury (TBI) patients in the ICU and changes in TyG index, as well as its relevance. Methods A cross-sectional study was conducted with a total of 492 individuals enrolled in the Medical Information Mart for Intensive Care IV(MIMIC-IV) database. Multivariate model logistic regression, smoothed curve fitting and forest plots were utilized to confirm the study objectives. The predictive power of the TyG index for outcome indicators was assessed using subject work characteristics (ROC) curves. As well as comparing the Integrated Discriminant Improvement Index and the Net Reclassification Index of the traditional forecasting model with the addition of the TyG index. Results Of all eligible subjects, 55.9% were male and the incidence of AKI was 59.3%. There was a statistically significant difference in the incidence of AKI within 7 days in the ICU between the different TyG index groups. The difference between TyG index and the risk of AKI within 7 days in the ICU remained significant after adjustment for logistic multifactorial modeling (OR = 2.07, 95% CI = 1.41-3.05, P < 0.001). A similar pattern of associations was observed in subgroup analyses (P values for all interactions were greater than 0.05). The addition of TyG index to the traditional risk factor model improved the predictive power of the risk of AKI within 7 days in ICU (P < 0.05). Conclusion The findings of this study demonstrate a strong association between the TyG index and the occurrence of AKI within 7 days in ICU patients. The TyG index can potentially be used as a risk stratification tool for early identification and prevention of AKI. Implementing preventive strategies targeting patients with a high TyG index may help reduce the burden of AKI in the ICU. Further prospective studies are warranted to validate these findings and explore the clinical utility of the TyG index in AKI prevention.

The triglyceride-glucose index dynamic trajectory reveals the association between the clinical subphenotype of insulin resistance and mortality in patients with sepsis

BACKGROUND

The relationship between the dynamic changes in insulin resistance (IR) and the prognosis of septic patients remains unclear. This study aims to investigate the correlation between the clinical subphenotype of IR represented by the triglyceride-glucose (TyG) index trajectory and the mortality rate among patients with sepsis.

METHODS

In this retrospective cohort study, we utilized data from septic patients within the Medical Information Mart for Intensive Care (MIMIC)-IV database version 2.0 to construct trajectories of the TyG index over 72 h. Subsequently, we computed the similarity among various TyG index trajectories with the dynamic time warping (DTW) algorithm and utilized the hierarchical clustering (HC) algorithm to demarcate distinct cluster and identified subphenotypes according to the trajectory trend. Subsequently, we assessed the mortality risk between different subphenotypes using analyses such as survival analysis and validated the robustness of the results through propensity score matching (PSM) and various models.

RESULTS

A total of 2350 patients were included in the study. Two trajectory trends: TyG index decreasing (n = 926) and TyG index increasing (n = 1424) were identified, which indicated corresponding to the clinical subphenotype of increased and alleviative IR respectively. The 28-day and in-hospital mortality for the increased IR group was 28.51% and 25.49% respectively. In comparison, patients in the alleviative IR group with a 28-day mortality of 23.54% and an in-hospital mortality of 21.60%. These subphenotypes exhibited distinct prognosis, time dependent Cox model showed the increased IR group with a higher 28-day mortality [hazard ratio (HR): 1.07, 95% confidence interval (CI): 1.02-1.12, P = 0.01] and in-hospital mortality [HR: 1.05, 95% CI: 1.00-1.11, P = 0.045] compared to the alleviative IR group. Sensitivity analyses with various models further validated the robustness of our findings.

CONCLUSION

Dynamic increase in the TyG index trajectory is associated with elevated mortality risk among patients with sepsis, which suggests that dynamic increased IR exacerbates the risk of poor outcomes in patients.

The role of the prognostic nutritional index in predicting mortality in stroke patients

OBJECTIVE

The aim of this study was to evaluate the role of the prognostic nutritional index in predicting in-hospital mortality among patients with acute ischemic stroke.

METHODS

This retrospective, observational study included patients diagnosed with acute ischemic stroke at the emergency department of the hospital between January 1, 2022, and January 1, 2023. Demographic data, vital parameters, comorbidities, stroke interventions, and laboratory data were collected from electronic medical records. Prognostic nutritional index was calculated using serum albumin levels and a total lymphocyte count. The primary outcome was in-hospital mortality.

RESULTS

The study included 176 patients, divided into survivor (93.2%, n=164) and deceased (6.8%, n=12) groups. No significant differences were observed in age, gender, blood pressure, heart rate, or body temperature between the groups. Atrial fibrillation was significantly more common in the deceased group (50%) compared to the survivor group (18.9%) (p=0.011). The median lymphocyte count was significantly higher in the survivor group (1,353 [interquartile range, IQR 984-1,968]/mm³) compared to the deceased group (660 [IQR 462-1,188]/mm³) (p=0.009). The median albumin level was significantly lower in the deceased group (3.31 [IQR 2.67-3.4] g/dL) compared to the survivor group (3.74 [IQR 3.39-4.21] g/dL) (p<0.001). The median prognostic nutritional index was significantly higher in the survivor group (46.05 [IQR 39.1-51.3]) compared to the deceased group (36.7 [IQR 28.7-40.5]) (p<0.001). The area under the receiver operating characteristic for prognostic nutritional index predicting mortality was 0.791 (95%CI 0.723-0.848) (p=0.0002), with a cut-off value of ≤41.92 providing the highest diagnostic accuracy.

CONCLUSIONS

Prognostic nutritional index is a valuable prognostic indicator for in-hospital mortality in acute ischemic stroke patients. Low prognostic nutritional index values are associated with increased mortality risk. Incorporating prognostic nutritional index into clinical practice may aid in the early identification of high-risk patients and the optimization of treatment strategies. Further research is needed to validate these findings and explore the broader clinical applications of prognostic nutritional index.

Non-linear association of triglyceride-glucose index with cardiovascular and all-cause mortality in T2DM patients with diabetic kidney disease: NHANES 2001-2018 retrospective cohort study

BACKGROUND

The triglyceride glucose (TyG) index is a cutting-edge and highly effective marker of insulin resistance, a crucial factor in the development and exacerbation of diabetic kidney disease (DKD). To date, there has been limited research on how the triglyceride-glucose (TyG) index affects the outlook for patients suffering from DKD.

METHODS

In this multicenter retrospective cohort study, the analysis recruited 2,203 DKD patients from the National Health and Nutrition Examination Survey (NHANES) dataset, which covers the US from 2001 to 2018. The research applied a Cox proportional hazards model with multiple variables to investigate the association of the TyG index with mortality outcomes. Restricted cubic splines (RCS) and methods for analyzing threshold effects were employed to identify possible non-linear relationships.

RESULTS

Over nearly 19 years of follow-up, this study captured data on 753 all-cause and 231 cardiovascular disease-specific fatalities. Sophisticated statistical methods, including RCS and smoothing curve adjustments via penalized splines, helped identify distinctive patterns: The baseline TyG index was observed to have a U-shaped pattern related to overall mortality and an L-shape with cardiovascular diseases(CVD) mortality among individuals with DKD. Notably, TyG index below 9.15 for overall mortality and 9.27 for CVD mortality were linked to reduced death rates (HR = 0.65, 95% CI = 0.52-0.82 for all-cause; HR = 0.58, 95% CI = 0.43-0.83 for CVD). On the other hand, TyG index exceeding these benchmarks (greater than 9.15 for all-cause and 9.27 for CVD) correlated with increased all-cause mortality risks (HR = 1.21, 95% CI = 1.02-1.43) and showed a non-significant change in CVD mortality risks (HR = 1.07, 95% CI = 0.83-1.38).

CONCLUSIONS

This study emphasizes the non-linear linkage involving the TyG index and death rates due to CVD and other factors in patients with DKD, demonstrating its effectiveness in estimating potential adverse events within this demographic.

Association between the triglyceride-glucose index and mortality in critically ill patients: A meta-analysis

BACKGROUND

To further identify the association of the triglyceride-glucose (TyG) index with the risk of mortality among critically ill patients admitted to the intensive care unit (ICU).

METHODS

The PubMed, Web of Science, and EMBASE databases were searched for relevant studies up to February 2, 2024. The primary outcomes were in-hospital mortality and ICU mortality. The secondary outcomes were 30-day mortality, 90-day mortality, and 1-year mortality. The hazard ratios (HRs) with 95% confidence intervals (CIs) were combined to evaluate the associations between the TyG index and the above endpoints. All the statistical analyses were performed with STATA 15.0 software.

RESULTS

Ten studies involving 22,694 patients were included. The pooled results demonstrated that an elevated TyG index indicated an increased risk of in-hospital mortality (HR = 1.76, 95% CI: 1.41-2.18, P < .001), ICU mortality (HR = 1.52, 95% CI: 1.33-1.74, P < .001), 30-day mortality (HR = 1.50, 95% CI: 1.02-2.19, P = .037), 90-day mortality (HR = 1.42, 95% CI: 1.01-2.00, P = .043), and 1-year mortality (HR = 1.19, 95% CI: 1.11-1.28, P < .001). Subgroup analysis for in-hospital mortality and ICU mortality based on sex, age, body mass index and hypertension showed similar results. However, subgroup analysis stratified by diabetes mellitus (DM) revealed that the associations of the TyG index with in-hospital mortality (HR = 2.21, 95% CI: 1.30-3.78, P = .004) and ICU mortality (HR = 1.93, 95% CI: 0.95-3.94, P = .070) were observed only among patients without DM.

CONCLUSION

The TyG index was significantly associated with mortality among critically ill patients without DM, and an elevated TyG index predicted an increased risk of mortality.

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.

Value of the triglyceride-glucose index and related parameters in heart failure patients

The triglyceride-glucose (TyG) index, proven to be a crucial insulin resistance biomarker (better than the Homeostasis Model Assessment for Insulin Resistance), is simple and non-invasive. Recently, indisputable evidence has shown that the TyG index is strongly associated with cardiovascular disease [CVD, including atherosclerosis, heart failure (HF), and hypertension] prognosis and mortality. Nevertheless, the value of the TyG index in HF patients treated with sodium-glucose cotransporter 2 inhibitors (SGLT2is) has not been systematically evaluated. Therefore, in this review, we summarized the value of the TyG index and its related parameters as markers of CVD, especially HF. Furthermore, we addressed the use of SGLT2is and GLP-1 receptor antagonists in HF patients. Finally, we summarized the mechanism of the "obesity paradox."

Association between triglyceride-glucose related indices and mortality among individuals with non-alcoholic fatty liver disease or metabolic dysfunction-associated steatotic liver disease

BACKGROUND

The prognostic value of triglyceride-glucose (TyG) related indices in non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is still unclear. This study aimed to determine the associations between TyG-related indices and long-term mortality in this population.

METHODS

The data came from the National Health and Nutrition Examination Survey (NHANES III) and National Death Index (NDI). Baseline TyG, TyG combining with body mass index (TyG-BMI), and TyG combining with waist circumference (TyG-WC) indices were calculated, and mortality status was determined through 31 December 2019. Multivariate Cox and restricted cubic spline (RCS) regression models were performed to evaluate the relationship between TyG-related indices and long-term mortality among participants with NAFLD/MASLD. In addition, we examined the association between TyG-related indices and all-cause mortality within subgroups defined by age, sex, race/ethnicity, and fibrosis-4 index (FIB-4).

RESULTS

There were 10,390 participants with completed ultrasonography and laboratory data included in this study. NAFLD was diagnosed in 3672/10,390 (35.3%) participants, while MASLD in 3556/10,390 (34.2%) amongst the overall population. The multivariate Cox regression analyses showed high levels of TyG-related indices, particularly in TyG-BMI and TyG-WC indices were significantly associated with the all-cause mortality, cardiovascular mortality, and diabetes mortality in either NAFLD or MASLD. The RCS curves showed a nonlinear trend between three TyG-related indices with all-cause mortality in either NAFLD or MASLD. Subgroup analyses showed that TyG-BMI and TyG-WC indices were more suitable for predicting all-cause mortality in patients without advanced fibrosis.

CONCLUSION

Our study highlights the clinical value of TyG-related indices in predicting the survival of the NAFLD/MASLD population. TyG-BMI and TyG-WC indices would be the surrogate biomarkers for the follow-up of the population without advanced fibrosis.

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.

Association between atherogenic index of plasma and new-onset stroke in individuals with different glucose metabolism status: insights from CHARLS

BACKGROUND

Circulating atherogenic index of plasma (AIP) levels has been proposed as a novel biomarker for dyslipidemia and as a predictor of insulin resistance (IR) risk. However, the association between AIP and the incidence of new-onset stroke, particularly in individuals with varying glucose metabolism status, remains ambiguous.

METHODS

A total of 8727 participants aged 45 years or older without a history of stroke from the China Health and Retirement Longitudinal Study (CHARLS) were included in this study. The AIP was calculated using the formula log [Triglyceride (mg/dL) / High-density lipoprotein cholesterol (mg/dL)]. Participants were divided into four groups based on their baseline AIP levels: Q1 (AIP ≤ 0.122), Q2 (0.122 < AIP ≤ 0.329), Q3 (0.329 < AIP ≤ 0.562), and Q4 (AIP > 0.562). The primary endpoint was the occurrence of new-onset stroke events. The Kaplan-Meier curves, multivariate Cox proportional hazard models, and Restricted cubic spline analysis were applied to explore the association between baseline AIP levels and the risk of developing a stroke among individuals with varying glycemic metabolic states.

RESULTS

During an average follow-up of 8.72 years, 734 participants (8.4%) had a first stroke event. The risk for stroke increased with each increasing quartile of baseline AIP levels. Kaplan-Meier curve analysis revealed a significant difference in stroke occurrence among the AIP groups in all participants, as well as in those with prediabetes mellitus (Pre-DM) and diabetes mellitus (DM) (all P values < 0.05). After adjusting for potential confounders, the risk of stroke was significantly higher in the Q2, Q3, and Q4 groups than in the Q1 group in all participants. The respective hazard ratios (95% confidence interval) for stroke in the Q2, Q3, and Q4 groups were 1.34 (1.05-1.71), 1.52 (1.19-1.93), and 1.84 (1.45-2.34). Furthermore, high levels of AIP were found to be linked to an increased risk of stroke in both pre-diabetic and diabetic participants across all three Cox models. However, this association was not observed in participants with normal glucose regulation (NGR) (p > 0.05). Restricted cubic spline analysis also demonstrated that higher baseline AIP levels were associated with higher hazard ratios for stroke in all participants and those with glucose metabolism disorders.

CONCLUSIONS

An increase in baseline AIP levels was significantly associated with the risk of stroke in middle-aged and elderly individuals, and exhibited distinct characteristics depending on the individual's glucose metabolism status.

Association between triglyceride glucose-body mass index and all-cause mortality in critically ill patients with acute myocardial infarction: retrospective analysis of the MIMIC-IV database

Background

Insulin resistance (IR) is closely related to the development of cardiovascular diseases. Triglyceride-glucose-body mass index (TyG-BMI) has been proven to be a reliable surrogate of IR, but the relationship between TyG-BMI and acute myocardial infarction (AMI) is unknown. The present study aims to determine the effects of TyG-BMI on the clinical prognosis of critically ill patients with AMI.

Methods

The data of AMI patients were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. All patients were divided into four groups according to the TyG-BMI quartile. Outcomes were defined as 30-, 90-, 180-, and 365-day all-cause mortality. Kaplan-Meier (K-M) curve was used to compare survival rate between groups. Meanwhile, Cox regression analysis and restricted cubic splines (RCS) were used to explore the relationship between TyG-BMI index and outcome events.

Results

A total of 1,188 critically ill patients with AMI were included in this study. They were divided into four groups according to TyG-BMI quartiles, there were significant differences in 90-, 180-, and 365-day all-cause mortality while there was no difference in 30-day all-cause mortality. Interestingly, with the increase of TyG-BMI, the 90-, 180-, and 365-day survival rate increased first and then gradually decreased, but the survival rate after decreasing was still higher than that in the group with the lowest TyG-BMI. U-shaped relationships between TyG-BMI index and 90-, 180-, and 365-day all-cause mortality were identified using RCS curve and the inflection point was 311.1, 316.5, and 320.1, respectively, whereas the TyG-BMI index was not non-linearly associated with 30-day all-cause mortality. The results of Cox proportional hazard regression analysis are consistent with those of RCS analysis.

Conclusion

U-shaped relationships are existed between the TyG-BMI index and 90-, 180-, and 365-day all-cause mortality in critically ill patients with AMI, but not 30-day all-cause mortality. The TyG-BMI index can be used as an effective index for early prevention of critically ill patients with AMI.

Association of the TyG index with prognosis in surgical intensive care patients: data from the MIMIC-IV

BACKGROUND

The triglyceride-glucose (TyG) index, a tool for assessing insulin resistance, is increasingly recognized for its ability to predict cardiovascular and metabolic risks. However, its relationship with trauma and surgical patient prognosis is understudied. This study investigated the correlation between the TyG index and mortality risk in surgical/trauma ICU patients to identify high-risk individuals and improve prognostic strategies.

METHODS

This study identified patients requiring trauma/surgical ICU admission from the Medical Information Mart for Intensive Care (MIMIC-IV) database, and divided them into tertiles based on the TyG index. The outcomes included 28-day mortality and 180-day mortality for short-term and long-term prognosis. The associations between the TyG index and clinical outcomes in patients were elucidated using Cox proportional hazards regression analysis and RCS models.

RESULTS

A total of 2103 patients were enrolled. The 28-day mortality and 180-day mortality rates reached 18% and 24%, respectively. Multivariate Cox proportional hazards analysis revealed that an elevated TyG index was significantly related to 28-day and 180-day mortality after covariates adjusting. An elevated TyG index was significantly associated with 28-day mortality (adjusted hazard ratio, 1.19; 95% confidence interval 1.04-1.37) and 180-day mortality (adjusted hazard ratio, 1.24; 95% confidence interval 1.11-1.39). RCS models revealed that a progressively increasing risk of mortality was related to an elevated TyG index. According to our subgroup analysis, an elevated TyG index is associated with increased risk of 28-day and 180-day mortality in critically ill patients younger than 60 years old, as well as those with concomitant stroke or cardiovascular diseases. Additionally, in nondiabetic patients, an elevated TyG index is associated with 180-day mortality.

CONCLUSION

An increasing risk of mortality was related to an elevated TyG index. In critically ill patients younger than 60 years old, as well as those with concomitant stroke or cardiovascular diseases, an elevated TyG index is associated with adverse short-term and long-term outcomes. Furthermore, in non-diabetic patients, an elevated TyG index is associated with adverse long-term prognosis.

Prognostic value of the systemic immune-inflammation index in critically ill elderly patients with hip fracture: evidence from MIMIC (2008-2019)

Background

The systemic immune-inflammation index (SII) showed an extensive link between immunological dysfunction and the activation of systemic inflammation. Several studies have confirmed the application of SII to orthopedic diseases. However, the significance of SII in critically ill elderly individuals with hip fracture who require intensive care unit (ICU) admission is not yet known. This study centered on exploring the relationship between SII and clinical outcomes among critically ill elderly hip fracture individuals.

Methods

The study centered around elderly patients experiencing severe illness following hip fractures and requiring admission to the ICU. These patients from the MIMIC-IV database formed the basis of this study's cohort. We stratified them into quartiles according to their SII levels. The results involved the mortality at 30 days and 1 year post-admission. Then we employ Cox proportional hazards regression analysis as well as restricted cubic splines to explore the association between the SII and clinical results in critically ill elderly patients with hip fracture.

Results

The study encompassed 991 participants, among whom 63.98% identified as females. Notably, the mortality rates attributed to any cause within 30 days and 1 year after hospitalization stood at 19.68 and 33.40%, respectively. The multivariate Cox proportional hazards model disclosed a significant correlation between an elevated SII and all-cause mortality. Following adjustments for confounding variables, individuals with a high SII showed a notable correlation with 30-day mortality [adjusted hazard ratio (HR), 1.065; 95% confidence interval (CI), 1.044-1.087; p < 0.001] and 1-year mortality (adjusted HR, 1.051; 95% CI, 1.029-1.074; p < 0.001). Furthermore, the analysis of restricted cubic splines demonstrated a progressive increase in the risk of all-cause death as the SII value rose.

Conclusion

Among critically ill elderly patients with hip fracture, the SII exhibits a non-linear association that positively correlates with both 30-day and 1-year all-cause mortality rates. The revelation indicates that the SII may play a vital role in identifying patients with hip fractures who face an escalated risk of mortality due to any cause.

Triglyceride-glucose index as a potential predictor for in-hospital mortality in critically ill patients with intracerebral hemorrhage: a multicenter, case-control study

BACKGROUND

The correlation between the triglyceride-glucose index (TyG) and the prognosis of ischemic stroke has been well established. This study aims to assess the influence of the TyG index on the clinical outcomes of critically ill individuals suffering from intracerebral hemorrhage (ICH).

METHODS

Patients diagnosed with ICH were retrospectively retrieved from the Medical Information Mart for Intensive Care (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD). Various statistical methods, including restricted cubic spline (RCS) regression, multivariable logistic regression, subgroup analysis, and sensitivity analysis, were employed to examine the relationship between the TyG index and the primary outcomes of ICH.

RESULTS

A total of 791 patients from MIMIC-IV and 1,113 ones from eICU-CRD were analyzed. In MIMIC-IV, the in-hospital and ICU mortality rates were 14% and 10%, respectively, while in eICU-CRD, they were 16% and 8%. Results of the RCS regression revealed a consistent linear relationship between the TyG index and the risk of in-hospital and ICU mortality across the entire study population of both databases. Logistic regression analysis revealed a significant positive association between the TyG index and the likelihood of in-hospital and ICU death among ICH patients in both databases. Subgroup and sensitivity analysis further revealed an interaction between patients' age and the TyG index in relation to in-hospital and ICU mortality among ICH patients. Notably, for patients over 60 years old, the association between the TyG index and the risk of in-hospital and ICU mortality was more pronounced compared to the overall study population in both MIMIC-IV and eICU-CRD databases, suggesting a synergistic effect between old age (over 60 years) and the TyG index on the in-hospital and ICU mortality of patients with ICH.

CONCLUSIONS

This study established a positive correlation between the TyG index and the risk of in-hospital and ICU mortality in patients over 60 years who diagnosed with ICH, suggesting that the TyG index holds promise as an indicator for risk stratification in this patient population.

Long-term survival in stroke patients: insights into triglyceride-glucose body mass index from ICU data

BACKGROUND

The Triglyceride Glucose-Body Mass Index (TyG-BMI) has been established as a robust indicator of insulin resistance (IR), reflecting metabolic health across various populations. In general, lower TyG-BMI values are often associated with better metabolic health outcomes and a reduced risk of adverse health events in non-critically ill populations. Previous studies have highlighted a significant negative association between TyG-BMI and all-cause mortality (ACM) among critically ill atrial fibrillation patients. Given the high prevalence and severe outcomes associated with stroke, understanding how TyG-BMI at the time of ICU admission correlates with ACM in critically ill stroke patients becomes imperative. This study aims to assess the correlation between TyG-BMI and ACM in this specific patient cohort, exploring how traditional associations between TyG-BMI and metabolic health may differ in the context of acute, life-threatening illness.

METHODS

Patient data were retrieved by accessing the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database, categorizing patients into three groups on the basis of TyG-BMI tertiles. The study evaluated both primary and secondary outcomes: the primary outcomes included the 90-day, 180-day, and 1-year ACM, while secondary outcomes encompassed ICU, in-hospital, and 30-day ACM. Our study employed the Kaplan-Meier (K-M) curve method for outcome comparison across the groups while utilizing multivariate Cox proportional-hazards regression models and restricted cubic splines (RCS) to explore TyG-BMI association with these outcomes. Additionally, interaction and subgroup analyses were performed, focusing on different mortality time points.

RESULTS

Among a cohort of 1707 individuals diagnosed with stroke, the average age was 68 years (interquartile range [IQR]: 58-78 years), with 946 (55.42%) of the participants being male. The analysis of K-M curves suggested that patients having a lower TyG-BMI level faced a heightened risk of long-term ACM, whereas the short-term ACM exhibited no statistically significant differences across the three TyG-BMI groups. Furthermore, Cox proportional-hazards regression analysis validated a statistically significant increased risk of long-term ACM among patients belonging to the lowest TyG-BMI tertile. Additionally, RCS analysis results demonstrated L-shaped correlations between the TyG-BMI index and both short- and long-term ACM. These findings underscore the TyG-BMI predictive value for long-term mortality in stroke patients, highlighting a nuanced relationship that varies over different time frames. The results revealed no interactions between TyG-BMI and the stratified variables, with the exception of age.

CONCLUSION

In our study, lower TyG-BMI levels in critically ill stroke patients are significantly related to a higher risk of long-term ACM within the context of the United States. This finding suggests the potential of TyG-BMI as a marker for stratifying long-term risk in this patient population. However, it's crucial to note that this association was not observed for short-term ACM, indicating that the utility of TyG-BMI may be more pronounced in long-term outcome prediction. Additionally, our conclusion that TyG-BMI could serve as a reliable indicator for managing and stratifying stroke patients over the long term is preliminary. To confirm our findings and assess the universal applicability of TyG-BMI as a prognostic tool, it is crucial to conduct rigorously designed research across various populations.

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.

Associations of triglyceride-glucose (TyG) index with chest pain incidence and mortality among the U.S. population

BACKGROUND

The triglyceride and glucose (TyG) index, a simple surrogate marker of insulin resistance, is related to cardiovascular disease. However, there is a lack of evidence for the relationship between the TyG index and chest pain. This study aimed to investigate the association of the TyG index with chest pain and to evaluate the relationship between the TyG index and all-cause mortality in participants with or without chest pain.

METHODS

The present study utilized data from the 2001-2012 National Health and Nutrition Examination Survey (NHANES), employing a combination of cross-sectional and cohort study designs. The association between the TyG index and chest pain was investigated using weighted logistic regression models. Weighted Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality. Restricted cubic spline analysis was used to explore linear or nonlinear relationships between the TyG index and chest pain or all-cause mortality.

RESULTS

The findings revealed a positive correlation between the TyG index and chest pain, even after adjusting for potential confounding factors (quartile 4 versus quartile 1, odds ratio [OR] 1.42, 95% confidence interval [CI] 1.14-1.77, P = 0.002). During a mean follow-up time of 139 months, a total of 2286 individuals (27.43%) experienced mortality. Weighted multivariate Cox regression models indicated that for each one-unit increase in the TyG index, the adjusted hazard ratio (HR) for mortality was 1.14 (95% CI = 0.94-1.37) for participants with chest pain and 1.25 (95% CI = 1.09-1.43) for those without chest pain. Furthermore, restricted cubic spline analysis revealed a linear relationship between the TyG index and chest pain (P for nonlinearity = 0.902), whereas a nonlinear relationship was shown between the TyG index and all-cause mortality among populations regardless of chest pain (all P for nonlinearity < 0.01).

CONCLUSION

The TyG index was positively linked to a higher incidence of chest pain. Moreover, the TyG index was associated with all-cause mortality not only in participants with chest pain but also in those without chest pain.

Triglyceride-glucose index: a novel evaluation tool for all-cause mortality in critically ill hemorrhagic stroke patients-a retrospective analysis of the MIMIC-IV database

BACKGROUND

Hemorrhagic stroke (HS), including non-traumatic intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), constitutes a substantial proportion of cerebrovascular incidents, accounting for around 30% of stroke cases. The triglyceride-glucose index (TyG-i) represents a precise insulin resistance (IR) indicator, a crucial metabolic disturbance. Existing literature has demonstrated an association between TyG-i and all-cause mortality (ACM) among individuals suffering from ischemic stroke (IS). Yet, the TyG-i prognostic implications for severe HS patients necessitating intensive care unit (ICU) admission are not clearly understood. Considering the notably elevated mortality and morbidity associated with HS relative to IS, investigating this association is warranted. Our primary aim was to investigate TyG-i and ACM association among critically ill HS patients within an ICU context.

METHODS

Herein, patients with severe HS were identified by accessing the Medical Information Mart for Intensive Care-IV (MIMIC-IV, version 2.2) database, using the International Classification of Diseases (ICD)-9/10 as diagnostic guidelines. Subsequently, we stratified the subjects into quartiles, relying on their TyG-i scores. Moreover, we measured mortality at ICU, in-hospital, 30 days, 90 days, and 1 year as the outcomes. Cox proportional hazards regression analysis and restricted cubic splines (RCS) were deployed for elucidating the relation between the TyG-i and ACM while utilizing the Kaplan-Meier (K-M) method to estimate survival curves. The findings' robustness was assessed by conducting subgroup analysis and interaction tests employing likelihood ratio tests.

RESULTS

The analysis included 1475 patients, with a male predominance of 54.4%. Observed mortality rates in the ICU, hospital, 30 days, 90 days, and 1 year were 7.3%, 10.9%, 13.8%, 19.7%, and 27.3%, respectively. Multivariate Cox regression analysis results manifested that heightened TyG-i was significantly related to ACM at 30 days (adjusted hazard ratio [aHR]: 1.32; 95% confidence interval [CI]: 1.05-1.67; P = 0.020), 90 days (aHR: 1.27; 95% CI: 1.04-1.55; P = 0.019), and 1 year (aHR: 1.22; 95% CI: 1.03-1.44; P = 0.023). The results of RCS analysis demonstrated a progressive elevation in ACM risk with rising TyG-i levels. Interaction tests found no significant effect modification in this relationship.

CONCLUSION

In summary, TyG-i exhibits a significant correlation with ACM among patients enduring critical illness due to HS. This correlation underscores the probable utility of TyG-i as a prognostic tool for stratifying HS patients according to their risk of mortality. Applying TyG-i in clinical settings could enhance therapeutic decision-making and the management of disease trajectories. Additionally, this investigation augments existing research on the linkage between the TyG-i and IS, elucidating the TyG-i's role in predicting mortality across diverse stroke categories.

Association between triglyceride-glucose index and intracranial/extracranial atherosclerotic stenosis: findings from a retrospective study

OBJECTIVE

The association of the triglyceride-glucose (TyG) index with intracranial atherosclerotic stenosis (ICAS) and extracranial atherosclerotic stenosis (ECAS) is unclear. This study aimed to investigate the relationship of TyG index with the distribution and severity of ICAS and ECAS.

METHOD

Patients who underwent digital subtraction angiography (DSA) for evaluating ICAS/ECAS in Zhongnan Hospital of Wuhan University from January 2017 to October 2021 were retrospectively enrolled in our study. Clinical characteristics, DSA data, blood routine, lipid profile and fasting glucose were recorded. The association of TyG index and ICAS/ECAS status were investigated in four aspects: location and distribution of stenosis, stenosis severity and whether stenosis is symptomatic. Logistic regression models were used to evaluate the association. Restricted cubic splines were constructed to model the non-linear relationship between the TyG index and different arterial stenosis status.

RESULTS

Among 1129 included patients, the median age was 62 (IQR 55-68) years, and 71.3% were male. The median TyG index was 8.81 (8.40, 9.21). Elevated TyG index was significantly associated with ICAS, combined ICAS/ECAS, anterior circulation stenosis, posterior circulation stenosis, combined anterior/posterior circulation stenosis, severe stenosis, both asymptomatic and symptomatic stenosis. This association was maintained after adjusting for age, sex, smoking, drinking, medical history of hypertension and stroke, platelet, total cholesterol, high-density lipoprotein, and low-density lipoprotein. Multivariable-adjusted spline regression models showed that a progressively increasing risk of arterial stenosis was related to an elevated TyG index.

CONCLUSION

Elevated TyG index was associated with ICAS/ECAS. TyG index might be a useful indicator of ICAS and severe stenosis.