Triglyceride-glucose index and mortality in critically ill patients with cardiovascular-kidney-metabolic syndrome stage 4.

The 1-year all-cause mortality in critically ill CKM stage 4 patients was 34.18% overall, with mortality increasing across TyG index tertiles.

• Total cohort of 3,125 patients was included, of whom 65.22% were male.
• 1-year all-cause mortality was 28.79% in Q1, 35.06% in Q2, and 38.68% in Q3.
• Difference across tertiles was statistically significant (P < 0.05).
• Data were sourced from the MIMIC-IV database in a retrospective study design.

Each 1-standard deviation increase in the TyG index was independently associated with a 23% higher risk of 1-year all-cause mortality in multivariable Cox regression.

• HR = 1.23, 95% CI 1.09–1.39 for each 1-SD increase in TyG index.
• Analysis used multivariable Cox proportional hazards models.
• The association was independent of other clinical covariates included in the model.

Patients in the highest TyG index tertile (Q3) had a 30% higher 1-year mortality risk compared to those in the lowest tertile (Q1).

• HR = 1.30, 95% CI 1.08–1.55 for Q3 vs. Q1.
• Patients were categorized into tertiles of the TyG index for this comparison.
• This association was derived from multivariable Cox regression analysis.

Restricted cubic spline analysis revealed a linear positive relationship between the TyG index and mortality.

• P for non-linearity > 0.05, indicating the relationship was linear rather than non-linear.
• RCS analysis was used alongside Cox proportional hazards models to evaluate the dose-response relationship.
• The linear association suggests a consistent incremental increase in mortality risk with higher TyG values.

The TyG index is proposed as a simple indicator of acute metabolic disturbances that could support early risk stratification in critically ill CKM stage 4 patients.

• The TyG index is a well-established surrogate marker of insulin resistance (IR).
• Previous studies linked higher TyG levels to increased cardiovascular event risk in early-stage (0–3) CKM, but its prognostic value in CKM stage 4 was previously unclear.
• The authors note that its role in clinical decision-making and potential utility in guiding interventions require confirmation in prospective studies.