甘油三酯-葡萄糖指数与心源性休克患者短期死亡率的关联：一项队列研究

Associations of the triglyceride-glucose index with short-term mortality in patients with cardiogenic shock: a cohort study.

作者信息

Mo Degang, Zhang Peng, Wang Mengmeng, Guan Jun, Dai Hongyan

机构信息

School of Medicine, Qingdao University, Qingdao, 266000, China.

Department of Cardiology, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266071, China.

出版信息

Lipids Health Dis. 2025 Apr 4;24(1):130. doi: 10.1186/s12944-025-02548-z.

DOI:10.1186/s12944-025-02548-z

PMID:40186173

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11969958/

Abstract

BACKGROUND

Cardiogenic shock (CS) is a severe cardiac disorder with a high mortality rate. The triglyceride-glucose (TyG) index, a biomarker of insulin resistance, is associated with cardiovascular disease-related mortality. This study aimed to investigate the association between the TyG index and mortality in patients with CS.

METHODS

This retrospective cohort study analyzed 727 patients with CS from the Medical Information Mart for Intensive Care IV database. The TyG index was calculated as follows: ln[triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Outcomes included 28-day intensive care unit (ICU) mortality and 28-day in-hospital mortality. Kaplan-Meier survival curve models and Cox proportional hazards regression models were used to evaluate the prognostic significance of the TyG index. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive efficacy of the TyG index for mortality. Subgroup analyses were conducted to determine the association between the TyG index and mortality across different groups.

RESULTS

Non-survivors had a significantly higher TyG index (ICU: 9.30 vs. 9.13, p = 0.008; in-hospital: 9.29 vs. 9.13, p = 0.004). Adjusted Cox models showed that each 1-unit increase in the TyG index increased ICU mortality risk by 24% (hazard ratio [HR] = 1.24, 95% confidence interval [CI]:1.04-1.48; p = 0.015) and in-hospital mortality by 44% (HR = 1.44, 95% CI:1.11-1.88; p = 0.007). The Quartile 4 TyG index ICU mortality was increased by 77% (HR = 1.77, 95% CI:1.09-2.89) compared to that for Quartile 1 and in-hospital mortality was increased by 61% (HR = 1.61, 95% CI:1.08-2.38). The area under the ROC curve (AUROC) showed a modest standalone predictive ability of 0.56, but when combined with clinical variables, the AUROC improved to 0.80 (ICU) and 0.78 (in-hospital). Subgroup analyses identified stronger associations in patients ≥ 60 years, females, non-septic, and those with acute myocardial infarction or heart failure.

CONCLUSIONS

The TyG index is significantly associated with short-term mortality in patients with CS and may serve as a useful biomarker for risk stratification.

TRIAL REGISTRATION

Not applicable.

摘要

背景

心源性休克（CS）是一种严重的心脏疾病，死亡率很高。甘油三酯-葡萄糖（TyG）指数作为胰岛素抵抗的生物标志物，与心血管疾病相关死亡率有关。本研究旨在探讨TyG指数与CS患者死亡率之间的关联。

方法

这项回顾性队列研究分析了重症监护医学信息数据库IV中的727例CS患者。TyG指数的计算方法如下：ln[甘油三酯（mg/dL）×空腹血糖（mg/dL）/2]。结局指标包括28天重症监护病房（ICU）死亡率和28天院内死亡率。采用Kaplan-Meier生存曲线模型和Cox比例风险回归模型评估TyG指数的预后意义。采用受试者工作特征（ROC）曲线分析确定TyG指数对死亡率的预测效能。进行亚组分析以确定不同组中TyG指数与死亡率之间的关联。

结果

未存活者的TyG指数显著更高（ICU：9.30对9.13，p = 0.008；院内：9.29对9.13，p = 0.004）。校正后的Cox模型显示，TyG指数每增加1个单位，ICU死亡风险增加24%（风险比[HR]=1.24，95%置信区间[CI]：1.04 - 1.48；p = 0.015），院内死亡风险增加44%（HR = 1.44，95% CI：1.11 - 1.88；p = 0.007）。与第一四分位数相比，第四四分位数的TyG指数使ICU死亡率增加77%（HR = 1.77，95% CI：1.09 - 2.89），院内死亡率增加61%（HR = 1.61，95% CI：1.08 - 2.38）。ROC曲线下面积（AUROC）显示其独立预测能力一般，为0.56，但与临床变量结合时，AUROC分别提高到0.80（ICU）和0.78（院内）。亚组分析发现，在年龄≥60岁、女性、非脓毒症以及患有急性心肌梗死或心力衰竭的患者中，关联更强。