Qiu Xingyu, Zhang Yu, He Jialing, Zhang Renjie, Wen Dingke, Wang Xing, You Chao, Fang Fang, Ma Lu
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
Acta Neurochir (Wien). 2025 Apr 22;167(1):113. doi: 10.1007/s00701-025-06533-4.
This study aimed to investigate the association between the triglyceride-glucose (TyG) index and the risk of acute kidney injury (AKI) in patients with aneurysmal subarachnoid hemorrhage (aSAH).
This retrospective cohort study included aSAH patients in West China Hospital. The TyG index was calculated as ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The primary outcome was AKI within 7 days of admission, and secondary outcomes included hospital, 90-day, and 180-day mortality. Multivariate logistic regression and Cox proportional hazards models were used to adjust for potential confounders. The association between the TyG index and AKI was also assessed with restricted cubic spline analysis. A predictive logistic model for AKI risk was developed and its performance was assessed using the area under the receiver operating characteristic curve, calibration correction curves, and decision curve analysis. Based on the optimal model, an online Shiny R application was developed.
A total of 3271 patients with aneurysmal subarachnoid hemorrhage were included. AKI occurred in 156 patients (4.7%), with the incidence significantly increasing across TyG index quartiles (Q1: 2.7%, Q4: 8.6%; P for trend < 0.001). Each 1-unit increase in TyG index was associated with an 90% higher odds of AKI (OR 1.90, 95% CI 1.48-2.45). Mortality rates also increased with higher TyG quartiles: hospital mortality (HR 1.30, 95% CI 1.05-1.62), 90-day mortality (HR 1.20, 95% CI 1.03-1.39), and 180-day mortality (HR 1.18, 95% CI 1.02-1.37). Kaplan-Meier analysis revealed reduced survival in higher TyG quartiles (Log-rank P < 0.001). Subgroup analyses confirmed consistent associations across demographics characteristics and treatment modalities. Incorporating the TyG index into risk models improves their discriminatory power and calibration. A Shiny application based on this model is freely accessible at ( https://asahaki.shinyapps.io/asahaki/ ).
The TyG index is an independent predictor of AKI and mortality in aSAH patients. Its incorporation into clinical assessment facilitates early risk stratification and individualized management.
本研究旨在探讨动脉瘤性蛛网膜下腔出血（aSAH）患者中甘油三酯-葡萄糖（TyG）指数与急性肾损伤（AKI）风险之间的关联。
这项回顾性队列研究纳入了华西医院的aSAH患者。TyG指数的计算方法为ln[空腹甘油三酯（mg/dL）×空腹血糖（mg/dL）/2]。主要结局是入院7天内发生的AKI，次要结局包括住院死亡率、90天死亡率和180天死亡率。采用多变量逻辑回归和Cox比例风险模型对潜在混杂因素进行校正。还使用受限立方样条分析评估TyG指数与AKI之间的关联。建立了AKI风险的预测逻辑模型，并使用受试者操作特征曲线下面积、校准校正曲线和决策曲线分析评估其性能。基于最优模型，开发了一个在线Shiny R应用程序。
共纳入3271例动脉瘤性蛛网膜下腔出血患者。156例患者（4.7%）发生了AKI，其发生率在TyG指数四分位数范围内显著增加（Q1：2.7%，Q4：8.6%；趋势P<0.001）。TyG指数每增加1个单位，AKI的发生几率高90%（OR 1.90，95%CI 1.48-2.45）。死亡率也随着TyG四分位数的升高而增加：住院死亡率（HR 1.30，95%CI 1.05-1.62）、90天死亡率（HR 1.20，95%CI 1.03-1.39）和180天死亡率（HR 1.18，95%CI 1.02-1.37）。Kaplan-Meier分析显示，TyG四分位数较高的患者生存率降低（对数秩P<0.001）。亚组分析证实，在不同人口统计学特征和治疗方式中，关联一致。将TyG指数纳入风险模型可提高其辨别能力和校准度。基于此模型的Shiny应用程序可在（https://asahaki.shinyapps.io/asahaki/）免费获取。
TyG指数是aSAH患者AKI和死亡率的独立预测指标。将其纳入临床评估有助于早期风险分层和个体化管理。
