Triglyceride-glucose Index Predicts Sepsis-associated Acute Kidney Injury and Length of Stay in Sepsis: A MIMIC-IV Cohort Study

Overview

Journal Heliyon

Specialty Social Sciences

Date 2024 Apr 15

PMID 38617935

Authors

Yijiao Fang

Bo Xiong

Xue Shang

Fan Yang

Yuehao Yin

Zhirong Sun

Xin Wu

Jun Zhang

Yi Liu

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Sepsis-Associated Acute Kidney Injury: What's New Regarding Its Diagnostics and Therapeutics?.

Kounatidis D, Tzivaki I, Daskalopoulou S, Daskou A, Adamou A, Rigatou A Diagnostics (Basel). 2025; 14(24.

PMID: 39767206 PMC: 11674886. DOI: 10.3390/diagnostics14242845.

Association between the triglyceride glucose index and acute kidney injury following traumatic brain injury.

Pan R, Li S, Wu B, Wang J, Lin S, Chen L Sci Rep. 2025; 15(1):456.

PMID: 39753656 PMC: 11698734. DOI: 10.1038/s41598-024-84690-9.

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

Xu H, Mo R, Liu Y, Niu H, Cai X, He P Front Med (Lausanne). 2024; 11:1500995.

PMID: 39712174 PMC: 11659220. DOI: 10.3389/fmed.2024.1500995.

A retrospective study utilized MIMIC-IV database to explore the potential association between triglyceride-glucose index and mortality in critically ill patients with sepsis.

Lou J, Xiang Z, Zhu X, Fan Y, Song J, Cui S Sci Rep. 2024; 14(1):24081.

PMID: 39402158 PMC: 11473526. DOI: 10.1038/s41598-024-75050-8.

The triglyceride-glucose index is a predictor of major adverse cardiovascular events in patients with coronary artery disease and psoriasis: a retrospective cohort study.

Fu B, Zeng Y, Wang M, Zhao L, Sun L, Wang T Diabetol Metab Syndr. 2024; 16(1):184.

PMID: 39085887 PMC: 11290256. DOI: 10.1186/s13098-024-01423-8.

References

Uchino S, Kellum J, Bellomo R, Doig G, Morimatsu H, Morgera S . Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005; 294(7):813-8. DOI: 10.1001/jama.294.7.813. View

Xiong C, Jia Y, Wu X, Zhao Y, Yuan S, Yan F . Early Postoperative Acetaminophen Administration and Severe Acute Kidney Injury After Cardiac Surgery. Am J Kidney Dis. 2022; 81(6):675-683.e1. DOI: 10.1053/j.ajkd.2022.11.009. View

Stasi A, Franzin R, Fiorentino M, Squiccimarro E, Castellano G, Gesualdo L . Multifaced Roles of HDL in Sepsis and SARS-CoV-2 Infection: Renal Implications. Int J Mol Sci. 2021; 22(11). PMC: 8197836. DOI: 10.3390/ijms22115980. View

Yao H, Sun Y, Song S, Qi Y, Tao X, Xu L . Protective Effects of Dioscin against Lipopolysaccharide-Induced Acute Lung Injury through Inhibition of Oxidative Stress and Inflammation. Front Pharmacol. 2017; 8:120. PMC: 5359219. DOI: 10.3389/fphar.2017.00120. View

Wiersema R, Jukarainen S, Vaara S, Poukkanen M, Lakkisto P, Wong H . Two subphenotypes of septic acute kidney injury are associated with different 90-day mortality and renal recovery. Crit Care. 2020; 24(1):150. PMC: 7161019. DOI: 10.1186/s13054-020-02866-x. View

de Geus H, Bakker J, Lesaffre E, le Noble J . Neutrophil gelatinase-associated lipocalin at ICU admission predicts for acute kidney injury in adult patients. Am J Respir Crit Care Med. 2010; 183(7):907-14. DOI: 10.1164/rccm.200908-1214OC. View

Post E, Kellum J, Bellomo R, Vincent J . Renal perfusion in sepsis: from macro- to microcirculation. Kidney Int. 2016; 91(1):45-60. DOI: 10.1016/j.kint.2016.07.032. View

Bagshaw S, Bennett M, Haase M, Haase-Fielitz A, Egi M, Morimatsu H . Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med. 2009; 36(3):452-61. DOI: 10.1007/s00134-009-1724-9. View

Oppert M, Engel C, Brunkhorst F, Bogatsch H, Reinhart K, Frei U . Acute renal failure in patients with severe sepsis and septic shock--a significant independent risk factor for mortality: results from the German Prevalence Study. Nephrol Dial Transplant. 2007; 23(3):904-9. DOI: 10.1093/ndt/gfm610. View

10.

Cirstea M, Walley K, Russell J, Brunham L, Genga K, Boyd J . Decreased high-density lipoprotein cholesterol level is an early prognostic marker for organ dysfunction and death in patients with suspected sepsis. J Crit Care. 2016; 38:289-294. DOI: 10.1016/j.jcrc.2016.11.041. View

11.

Yang Y, Huang X, Wang Y, Leng L, Xu J, Feng L . The impact of triglyceride-glucose index on ischemic stroke: a systematic review and meta-analysis. Cardiovasc Diabetol. 2023; 22(1):2. PMC: 9825038. DOI: 10.1186/s12933-022-01732-0. View

12.

Bagshaw S, Lapinsky S, Dial S, Arabi Y, Dodek P, Wood G . Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy. Intensive Care Med. 2008; 35(5):871-81. DOI: 10.1007/s00134-008-1367-2. View

13.

Poston J, Koyner J . Sepsis associated acute kidney injury. BMJ. 2019; 364:k4891. PMC: 6890472. DOI: 10.1136/bmj.k4891. View

14.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

15.

Liao Y, Zhang R, Shi S, Zhao Y, He Y, Liao L . Triglyceride-glucose index linked to all-cause mortality in critically ill patients: a cohort of 3026 patients. Cardiovasc Diabetol. 2022; 21(1):128. PMC: 9270811. DOI: 10.1186/s12933-022-01563-z. View

16.

Esteghamati A, Ashraf H, Nakhjavani M, Najafian B, Hamidi S, Abbasi M . Insulin resistance is an independent correlate of increased urine albumin excretion: a cross-sectional study in Iranian Type 2 diabetic patients. Diabet Med. 2009; 26(2):177-81. DOI: 10.1111/j.1464-5491.2008.02653.x. View

17.

Bagshaw S, George C, Bellomo R . Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care. 2008; 12(2):R47. PMC: 2447598. DOI: 10.1186/cc6863. View

18.

Gordon B . Poor outcomes associated with low lipid and lipoprotein levels. Crit Care Med. 2004; 32(3):878-9. DOI: 10.1097/01.ccm.0000117318.84442.9f. View

19.

Johnson A, Bulgarelli L, Shen L, Gayles A, Shammout A, Horng S . MIMIC-IV, a freely accessible electronic health record dataset. Sci Data. 2023; 10(1):1. PMC: 9810617. DOI: 10.1038/s41597-022-01899-x. View

20.

Kaddourah A, Basu R, Bagshaw S, Goldstein S . Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med. 2016; 376(1):11-20. PMC: 5322803. DOI: 10.1056/NEJMoa1611391. View