Zhang Zhen, Jiang Yanwen, Luo Zhe, Fang Yi, Ding Xiaoqiang, Jiang Wuhua
Department of Nephrology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
Shanghai Institute of Kidney and Dialysis, 200032 Shanghai, China.
Rev Cardiovasc Med. 2025 Jun 17;26(6):28110. doi: 10.31083/RCM28110. eCollection 2025 Jun.
Acute kidney injury (AKI) is a major complication of cardiac surgery, particularly in patients with pre-existing chronic kidney disease (CKD), who are at higher risk due to their compromised renal function. This study investigated the association between the triglyceride-glucose (TyG) index, a marker of insulin resistance, and postoperative AKI in CKD patients undergoing cardiac surgery to enhance risk stratification and perioperative management.
This retrospective study included 542 patients with impaired renal function (estimated glomerular filtration rate (eGFR) 15-60 mL/min/1.73 m) undergoing cardiac surgery from January 2018 to December 2019. The TyG index was calculated as Ln(fasting triglycerides [mg/dL] × fasting blood glucose [mg/dL]/2), and outcomes were defined as postoperative AKI (per Kidney Disease: Improving Global Outcomes (KDIGO) criteria), in-hospital mortality, and length of hospital stay. Multivariate logistic regression and subgroup analyses assessed the association between TyG and these endpoints.
Among the 542 patients, 55.7% developed AKI, and the in-hospital mortality rate was 7.6%. In the multivariate regression analysis, the odds ratio for AKI with each unit increase in LnTyG was 0.43 (95% CI 0.02-8.70, = 0.579), while in the standardized TyG, it was 0.96 (95% CI 0.77-1.21, = 0.754). Subgroup analyses, stratified by age, sex, CKD stage, and diabetes status, revealed no significant associations across all strata (all for interaction > 0.05).
The TyG index is not significantly associated with AKI or prognosis after cardiac surgery in patients with kidney dysfunction. Further studies are needed to elucidate the role of insulin resistance in the pathogenesis of AKI.
急性肾损伤（AKI）是心脏手术的主要并发症，尤其是在已有慢性肾脏病（CKD）的患者中，这些患者由于肾功能受损而风险更高。本研究调查了胰岛素抵抗标志物甘油三酯-葡萄糖（TyG）指数与接受心脏手术的CKD患者术后AKI之间的关联，以加强风险分层和围手术期管理。
这项回顾性研究纳入了2018年1月至2019年12月期间接受心脏手术的542例肾功能受损患者（估计肾小球滤过率（eGFR）为15 - 60 mL/min/1.73 m²）。TyG指数计算为Ln（空腹甘油三酯[mg/dL]×空腹血糖[mg/dL]/2），结局定义为术后AKI（根据肾脏病：改善全球预后（KDIGO）标准）、住院死亡率和住院时间。多因素逻辑回归和亚组分析评估了TyG与这些终点之间的关联。
在542例患者中，55.7%发生了AKI，住院死亡率为7.6%。在多因素回归分析中，LnTyG每增加一个单位，AKI的比值比为0.43（95%CI 0.02 - 8.70，P = 0.579），而在标准化TyG中，比值比为0.96（95%CI 0.77 - 1.21，P = 0.754）。按年龄、性别、CKD分期和糖尿病状态分层的亚组分析显示，所有亚组均无显著关联（所有交互作用P>0.05）。
TyG指数与肾功能不全患者心脏手术后的AKI或预后无显著关联。需要进一步研究以阐明胰岛素抵抗在AKI发病机制中的作用。
