Triglyceride-glucose index linked to hospital mortality in critically ill stroke patients: an observational multicentre study on eICU database

Abstract

Background: The triglyceride‑glucose (TyG) index is a reliable surrogate of insulin resistance and a marker for ischemic stroke (IS) incident. Whether the TyG index predicts stroke outcome remains uncertain. This study investigated the prognostic value of the TyG index in critically ill stroke patients.Methods: This was a retrospective observational study that included stroke patients, and all data were extracted from the eICU Collaborative Research Database. The TyG index was calculated as the ln (fasting glucose level [mg/dL] × triglyceride level [mg/dL]/2). The outcomes included the hospital and intensive care unit (ICU) death. Multivariate logistic regression was used to determine independent risk factors. The smoothing curves and forest plots were illustrated.Results: A total of 4570 eligible subjects were enrolled. The mean level of TyG index was 9.1 ± 0.7. The hospital and ICU mortality rate were 10.3% and 5.0% respectively. TyG index as a continuous variable was associated hospital mortality in univariate analysis (OR 1.723, 95% CI 1.524-1.948, P < 0.001), adjusted model 1 (OR 1.861, 95% CI 1637-2.116, P < 0.001) and adjusted model 2 (OR 2.543, 95% CI 1.588-4.073, P < 0.001). TyG was also associated ICU mortality in univariate analysis (OR 2.146, 95% CI 1.826-2.523, P < 0.001), adjusted model 1 (OR 2.183, 95% CI 1.847-2.580, P < 0.001), and adjusted model 2 (OR 2.672, 95% CI 1.376-5.188, P < 0.001). The smoothing curves observed a continuous linear association after adjusting all covariates both in hospital and ICU mortality. Subgroup analysis demonstrated TyG index was associated with increased risk of hospital and ICU death in critically ill IS (P < 0.05), but not in hemorrhage stroke (P > 0.05).Conclusion: The TyG index is a potential predictor for hospital and ICU mortality in critically ill stroke patients, especially in IS patients.

Triglyceride-Glucose Index and the Prognosis of Patients with Acute Ischemic Stroke: A Meta-Analysis

“…Overall, 34 076 patients with acute IS from eight cohort studies 15 16 17 18 19 20 21 22 were included in the meta-analysis ( Table 1 ). Four prospective cohort studies 16 17 20 22 and four retrospective studies 15 18 19 21 were included, respectively, which were performed in China 15 16 17 19 20 22 , Korea 18 , and Singapore 21 . All the studies included hospitalized patients with acute IS, with mean ages varying from 62 to 72 years.…”

“…All the studies included hospitalized patients with acute IS, with mean ages varying from 62 to 72 years. TyG index was measured at admission, and the cutoffs for the analyses of TyG index varied among the included studies, with quartiles 15 16 17 22 , tertiles 20 , median 19 , receiver operating characteristic (ROC) curve analysis derived value 21 , and previous study evidenced cut-off for IR 18 , respectively. The follow-up durations were within hospitalization for one study 15 , three months for three studies 18 20 21 , and 12 months for the other four studies 16 17 19 22 .…”

“…TyG index was measured at admission, and the cutoffs for the analyses of TyG index varied among the included studies, with quartiles 15 16 17 22 , tertiles 20 , median 19 , receiver operating characteristic (ROC) curve analysis derived value 21 , and previous study evidenced cut-off for IR 18 , respectively. The follow-up durations were within hospitalization for one study 15 , three months for three studies 18 20 21 , and 12 months for the other four studies 16 17 19 22 . Possible confounding factors such as age, sex, National Institutes of Health Stroke Scale (NIHSS) at admission, comorbidities, and concomitant medications were adjusted to a varying degree in the included studies when the association between TyG index and the risks of outcomes of interest were presented.…”

“…Previous studies showed that a higher TyG index is independently associated with the risk of atherosclerotic CVDs, including stroke 13 14 . However, studies which evaluated the possible predictive role of TyG index for the prognosis of patients with acute IS showed inconsistent findings 15 16 17 18 19 20 21 22 . Some studies suggested that a higher TyG index may predict the mortality risk 15 21 22 or poor functional outcome 17 18 19 20 21 in patients with acute IS, but not all studies 16 .…”

“…However, studies which evaluated the possible predictive role of TyG index for the prognosis of patients with acute IS showed inconsistent findings 15 16 17 18 19 20 21 22 . Some studies suggested that a higher TyG index may predict the mortality risk 15 21 22 or poor functional outcome 17 18 19 20 21 in patients with acute IS, but not all studies 16 . In this study, we performed a meta-analytic evaluation of the observational studies to comprehensively investigate the association between TyG index and clinical outcomes patients with acute IS, including risk of all-cause mortality and poor functional outcome.…”