Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Cardiovasc Diabetol. 2023 Jul 27;22(1):190. doi: 10.1186/s12933-023-01918-0.
Triglyceride-glucose (TyG) index is an efficient indicator of insulin resistance and is proven to be a valuable marker in several cardiovascular diseases. However, the relationship between TyG index and cardiac arrest (CA) remains unclear. The present study aimed to investigate the association of the TyG index with the occurrence and clinical outcomes of CA.
In this retrospective, multicenter, observational study, critically ill patients, including patients post-CA, were identified from the eICU Collaborative Research Database and evaluated. The TyG index for each patient was calculated using values of triglycerides and glucose recorded within 24 h of intensive care unit (ICU) admission. In-hospital mortality and ICU mortality were the primary clinical outcomes. Logistic regression, restricted cubic spline (RCS), and correlation analyses were performed to explore the relationship between the TyG index and clinical outcomes. Propensity score matching (PSM), overlap weighting (OW), and inverse probability of treatment weighting (IPTW) were adopted to balance the baseline characteristics of patients and minimize selection bias to confirm the robustness of the results. Subgroup analysis based on different modifiers was also performed.
Overall, 24,689 critically ill patients, including 1021 patients post-CA, were enrolled. The TyG index was significantly higher in patients post-CA than in those without CA (9.20 (8.72-9.69) vs. 8.89 (8.45-9.41)), and the TyG index had a moderate discrimination ability to identify patients with CA from the overall population (area under the curve = 0.625). Multivariate logistic regression indicated that the TyG index was an independent risk factor for in-hospital mortality (OR = 1.28, 95% CI: 1.03-1.58) and ICU mortality (OR = 1.27, 95% CI: 1.02-1.58) in patients post-CA. RCS curves revealed that an increased TyG index was linearly related to higher risks of in-hospital and ICU mortality (P for nonlinear: 0.225 and 0.271, respectively). Even after adjusting by PSM, IPTW, and OW, the TyG index remained a risk factor for in-hospital mortality and ICU mortality in patients experiencing CA, which was independent of age, BMI, sex, etc. Correlation analyses revealed that TyG index was negatively correlated with the neurological status of patients post-CA.
Elevated TyG index is significantly associated with the occurrence of CA and higher mortality risk in patients post-CA. Our findings extend the landscape of TyG index in cardiovascular diseases, which requires further prospective cohort study.
三酰甘油-葡萄糖（TyG）指数是胰岛素抵抗的有效指标，已被证明是几种心血管疾病的有价值标志物。然而，TyG 指数与心搏骤停（CA）之间的关系尚不清楚。本研究旨在探讨 TyG 指数与 CA 的发生和临床结局之间的关系。
在这项回顾性、多中心、观察性研究中，从 eICU 协作研究数据库中确定了包括 CA 后患者在内的危重症患者，并进行了评估。每位患者的 TyG 指数通过记录入住重症监护病房（ICU）后 24 小时内的甘油三酯和葡萄糖值来计算。院内死亡率和 ICU 死亡率是主要的临床结局。采用逻辑回归、限制性三次样条（RCS）和相关分析来探讨 TyG 指数与临床结局之间的关系。采用倾向评分匹配（PSM）、重叠加权（OW）和逆概率治疗加权（IPTW）来平衡患者的基线特征，以最小化选择偏差，从而确认结果的稳健性。还根据不同的修饰剂进行了亚组分析。
总体而言，共纳入 24689 例危重症患者，其中 1021 例为 CA 后患者。CA 后患者的 TyG 指数明显高于无 CA 患者（9.20（8.72-9.69）比 8.89（8.45-9.41）），并且 TyG 指数具有中等的鉴别能力，可以从总体人群中识别出 CA 患者（曲线下面积=0.625）。多变量逻辑回归表明，TyG 指数是 CA 后患者院内死亡率（比值比[OR] = 1.28，95%置信区间[CI]：1.03-1.58）和 ICU 死亡率（OR = 1.27，95%CI：1.02-1.58）的独立危险因素。RCS 曲线显示，TyG 指数升高与院内和 ICU 死亡率升高呈线性相关（非线性 P 值分别为 0.225 和 0.271）。即使在调整 PSM、IPTW 和 OW 后，TyG 指数在经历 CA 的患者中仍然是院内死亡率和 ICU 死亡率的危险因素，这与年龄、BMI、性别等无关。相关性分析显示，TyG 指数与 CA 后患者的神经状态呈负相关。
升高的 TyG 指数与 CA 的发生和 CA 后患者的更高死亡率风险显著相关。我们的研究结果扩展了 TyG 指数在心血管疾病中的应用范围，需要进一步进行前瞻性队列研究。
