Triglyceride-glucose Index Linked to All-cause Mortality in Critically Ill Patients: a Cohort of 3026 Patients

Overview

Journal Cardiovasc Diabetol

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
Endocrinology

Date 2022 Jul 8

PMID 35804386

Authors

Ying Liao

Rongting Zhang

Shanshan Shi

Yukun Zhao

Yibo He

Lihua Liao

Xueqin Lin

Qian Guo

Yani Wang

Liling Chen

Weiguo Li

Shihai Li

Kaihong Chen

Yong Fang

Affiliations

Soon will be listed here.

Abstract

Background: Triglyceride-glucose (TyG) index as a reliable surrogate of insulin resistance (IR) has been shown to be related to adverse clinical outcomes in patients with acute coronary syndrome, heart failure, ischemic stroke and so on. However, the relationship between TyG index and all-cause mortality in intensive care unit (ICU) patients remains unknown. The purpose of this study was to investigate the correlation between TyG index and all-cause mortality to evaluate the impact of IR on the prognosis of this population.

Methods: This was a retrospective observational study that included 3026 patients who had an initial triglyceride and glucose data on the first day of ICU admission, and all data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. These patients were grouped into quartiles (Q1-Q4) according to TyG index. The Kaplan-Meier analysis was used to compare all-cause mortality among the above four groups. Cox proportional hazards analyses were performed to examine the association between TyG index and all-cause mortality.

Results: During 10.46 years of follow-up, 1148 (37.9%) patients died, of which 350 (11.6%) occurred during the hospital stay and 258 (8.5%) occurred during the ICU stay. Kaplan-Meier analysis showed that the risk of all-cause mortality was significantly higher in patients with higher TyG index (log-rank P = 0.021). Multivariable Cox proportional hazards analyses showed that the TyG index was an independent risk predictor of ICU death (HR: 1.72, 95% CI 1.18-2.52, P = 0.005) and hospital death (HR: 2.19, 95% CI 1.59-3.03, P < 0.001), and each 1-unit increased in the TyG index, a 1.19-fold increase in the risk of death during the hospital stay.

Conclusions: TyG index is strongly related to the all-cause mortality increasing in critically ill patients. This finding indicates that the TyG index might be useful in identifying people at high risk of ICU death and hospital death.

Citing Articles

Triglyceride-glucose index correlates with the incidences and prognoses of cardiac arrest following acute myocardial infarction: data from two large-scale cohorts.

Liu H, Wang L, Wang H, Hao X, Du Z, Li C Cardiovasc Diabetol. 2025; 24(1):108.

PMID: 40057710 PMC: 11890517. DOI: 10.1186/s12933-025-02641-8.

Glycemic variability and its association with short and long term clinical outcomes in critically ill patients with cerebral hemorrhage.

Wang D, He C, Zou S, Yu L, Han B, He L Sci Rep. 2025; 15(1):7820.

PMID: 40050399 PMC: 11885567. DOI: 10.1038/s41598-025-92415-9.

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

Xu H, Xia Y, Mo R, Liu Y BMC Infect Dis. 2025; 25(1):257.

PMID: 39994563 PMC: 11849171. DOI: 10.1186/s12879-025-10649-4.

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

Sharifi-Zahabi E, Nasiri N, Hajizadeh-Sharafabad F, Sharifi M, Saber A Nutr Diabetes. 2025; 15(1):8.

PMID: 39987150 PMC: 11846995. DOI: 10.1038/s41387-025-00366-x.

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

Lai W, Lin Y, Gao Z, Huang Z, Zhang T Sci Rep. 2025; 15(1):5854.

PMID: 39966431 PMC: 11836110. DOI: 10.1038/s41598-025-87416-7.

References

Brun J, Ghanassia E, Fedou C, Bordenave S, Raynaud de Mauverger E, Mercier J . Assessment of insulin sensitivity (S I) and glucose effectiveness (S G) from a standardized hyperglucidic breakfast test in type 2 diabetics exhibiting various levels of insulin resistance. Acta Diabetol. 2010; 50(2):143-53. DOI: 10.1007/s00592-010-0232-2. View

Yahia A, Szlavecz A, Knopp J, Abdul Razak N, Abu Samah A, Shaw G . Estimating Enhanced Endogenous Glucose Production in Intensive Care Unit Patients with Severe Insulin Resistance. J Diabetes Sci Technol. 2021; 16(5):1208-1219. PMC: 9445352. DOI: 10.1177/19322968211018260. View

Gao J, Hao Q, Gao M, Zhang K, Li X, Wang J . Triglyceride-glucose index in the development of peripheral artery disease: findings from the Atherosclerosis Risk in Communities (ARIC) Study. Cardiovasc Diabetol. 2021; 20(1):126. PMC: 8223290. DOI: 10.1186/s12933-021-01319-1. View

Knopp J, Chase J, Shaw G . Increased insulin resistance in intensive care: longitudinal retrospective analysis of glycaemic control patients in a New Zealand ICU. Ther Adv Endocrinol Metab. 2021; 12:20420188211012144. PMC: 8173630. DOI: 10.1177/20420188211012144. View

Kellum J, Lameire N . Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 17(1):204. PMC: 4057151. DOI: 10.1186/cc11454. View

Zhang M, Wang B, Liu Y, Sun X, Luo X, Wang C . Cumulative increased risk of incident type 2 diabetes mellitus with increasing triglyceride glucose index in normal-weight people: The Rural Chinese Cohort Study. Cardiovasc Diabetol. 2017; 16(1):30. PMC: 5333419. DOI: 10.1186/s12933-017-0514-x. View

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M . Intensive insulin therapy in critically ill patients. N Engl J Med. 2002; 345(19):1359-67. DOI: 10.1056/NEJMoa011300. View

da Silva A, Caldas A, Hermsdorff H, Bersch-Ferreira A, Torreglosa C, Weber B . Triglyceride-glucose index is associated with symptomatic coronary artery disease in patients in secondary care. Cardiovasc Diabetol. 2019; 18(1):89. PMC: 6625050. DOI: 10.1186/s12933-019-0893-2. View

Vasques A, Novaes F, da Saude de Oliveira M, Souza J, Yamanaka A, Pareja J . TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract. 2011; 93(3):e98-e100. DOI: 10.1016/j.diabres.2011.05.030. View

10.

Wang L, Zhang Z, Hu T . Effectiveness of LODS, OASIS, and SAPS II to predict in-hospital mortality for intensive care patients with ST elevation myocardial infarction. Sci Rep. 2021; 11(1):23887. PMC: 8668882. DOI: 10.1038/s41598-021-03397-3. View

11.

Saeed M, Carlson G, Little R, Irving M . Selective impairment of glucose storage in human sepsis. Br J Surg. 1999; 86(6):813-21. DOI: 10.1046/j.1365-2168.1999.01140.x. View

12.

Zhao Q, Cheng Y, Xu Y, Zhao Z, Liu C, Sun T . Comparison of various insulin resistance surrogates on prognostic prediction and stratification following percutaneous coronary intervention in patients with and without type 2 diabetes mellitus. Cardiovasc Diabetol. 2021; 20(1):190. PMC: 8449896. DOI: 10.1186/s12933-021-01383-7. View

13.

Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X . Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol. 2014; 13:146. PMC: 4209231. DOI: 10.1186/s12933-014-0146-3. View

14.

Liu X, He G, Lo K, Huang Y, Feng Y . The Triglyceride-Glucose Index, an Insulin Resistance Marker, Was Non-linear Associated With All-Cause and Cardiovascular Mortality in the General Population. Front Cardiovasc Med. 2021; 7:628109. PMC: 7840600. DOI: 10.3389/fcvm.2020.628109. View

15.

Huang R, Wang Z, Chen J, Bao X, Xu N, Guo S . Prognostic value of triglyceride glucose (TyG) index in patients with acute decompensated heart failure. Cardiovasc Diabetol. 2022; 21(1):88. PMC: 9158138. DOI: 10.1186/s12933-022-01507-7. View

16.

Shi W, Xing L, Jing L, Tian Y, Yan H, Sun Q . Value of triglyceride-glucose index for the estimation of ischemic stroke risk: Insights from a general population. Nutr Metab Cardiovasc Dis. 2019; 30(2):245-253. DOI: 10.1016/j.numecd.2019.09.015. View

17.

Tao L, Xu J, Wang T, Hua F, Li J . Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations. Cardiovasc Diabetol. 2022; 21(1):68. PMC: 9078015. DOI: 10.1186/s12933-022-01511-x. View

18.

Black P, Brooks D, Bessey P, Wolfe R, Wilmore D . Mechanisms of insulin resistance following injury. Ann Surg. 1982; 196(4):420-35. PMC: 1352701. DOI: 10.1097/00000658-198210000-00005. View

19.

Wang S, Shi J, Peng Y, Fang Q, Mu Q, Gu W . Stronger association of triglyceride glucose index than the HOMA-IR with arterial stiffness in patients with type 2 diabetes: a real-world single-centre study. Cardiovasc Diabetol. 2021; 20(1):82. PMC: 8063289. DOI: 10.1186/s12933-021-01274-x. View

20.

Vincent J, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter P . Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998; 26(11):1793-800. DOI: 10.1097/00003246-199811000-00016. View