Department of Cardiology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu, 322000, Zhejiang, China.
Cardiovasc Diabetol. 2023 Aug 31;22(1):232. doi: 10.1186/s12933-023-01971-9.
Insulin resistance (IR) can be effectively assessed using the dependable surrogate biomarker triglyceride-glucose (TyG) index. In various critical care contexts, like contrast-induced acute kidney injury (AKI), an elevated TyG index has demonstrated a robust correlation with the incidence of AKI. Nonetheless, the potential of the TyG index to predict AKI in critically ill patients with heart failure (HF) remains uncertain.
A cohort of participants was non-consecutively selected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and divided into quartiles based on their TyG index values. The incidence of AKI was the primary outcome. The secondary endpoint was in-hospital mortality within both the whole study population and the subset of AKI patients. The use of the renal replacement therapy (RRT) which represented the progression of AKI severity was also included as a secondary endpoint representing renal outcome. A restricted cubic splines model and Cox proportional hazards models were utilized to evaluate the association of TyG index with the risk of AKI in patients with HF in a critical condition. Kaplan-Meier survival analysis was employed to estimate primary and secondary endpoint disparities across groups differentiated by their TyG index.
This study included a total of 1,393 patients, with 59% being male. The incidence of AKI was 82.8%. Cox proportional hazards analyses revealed a significant association between TyG index and the incidence of AKI in critically ill patients with HF. The restricted cubic splines model illustrated the linear relationship between higher TyG index and increased risk of AKI in this specific patient population. Furthermore, the Kaplan-Meier survival analyses unveiled statistically significant differences in the use of RRT across the subset of AKI patients based on the quartiles of the TyG index.
The results highlight the TyG index as a robust and independent predictor of the incidence of AKI and poor renal outcome in patients with HF in a critical condition. However, further confirmation of causality necessitates larger prospective studies.
胰岛素抵抗（IR）可以通过可靠的替代生物标志物甘油三酯-葡萄糖（TyG）指数有效地进行评估。在各种重症监护环境中，如造影剂诱导的急性肾损伤（AKI），升高的 TyG 指数与 AKI 的发生率之间存在很强的相关性。然而，TyG 指数在心力衰竭（HF）危重症患者中预测 AKI 的潜力尚不确定。
从 Medical Information Mart for Intensive Care IV（MIMIC-IV）数据库中连续选择了一组参与者，并根据 TyG 指数值将他们分为四组。AKI 的发生率是主要结果。次要终点是全研究人群和 AKI 患者亚组的住院死亡率。肾脏替代治疗（RRT）的使用也作为 AKI 严重程度进展的次要终点纳入其中，代表肾脏结局。受限立方样条模型和 Cox 比例风险模型用于评估 TyG 指数与 HF 危重症患者 AKI 风险之间的关联。Kaplan-Meier 生存分析用于估计按 TyG 指数分组的主要和次要终点之间的差异。
这项研究共纳入了 1393 名患者，其中 59%为男性。AKI 的发生率为 82.8%。Cox 比例风险分析显示，TyG 指数与 HF 危重症患者 AKI 的发生率之间存在显著关联。受限立方样条模型表明，在这一特定患者群体中，较高的 TyG 指数与 AKI 风险增加之间存在线性关系。此外，Kaplan-Meier 生存分析显示，根据 TyG 指数的四分位数，在 AKI 患者亚组中，RRT 的使用存在统计学显著差异。
这些结果强调了 TyG 指数作为 HF 危重症患者 AKI 发生率和不良肾脏结局的一个强大且独立的预测因子。然而，需要更大的前瞻性研究来进一步证实因果关系。
