Li Tengli, Yi Zhiheng, Huang Yangshen, Tan Yuhan, Gao Shan, Wang Tingting, Guo Shaowei
Department of Neurology, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China.
Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong Province, China.
Cardiovasc Diabetol. 2025 Aug 18;24(1):337. doi: 10.1186/s12933-025-02901-7.
The triglyceride-glucose (TyG) index and stress hyperglycemia ratio (SHR) are emerging biomarkers in cerebrovascular diseases, but their combined prognostic value for mortality in patients with critically ill stroke remains unexplored. This study, based on a cohort of critically ill patients with stroke, aims to investigate the prognostic value of the combined TyG index and SHR in predicting all-cause mortality at multiple time points in this high-risk population.
Based on the Medical Information Mart for Intensive Care (MIMIC)-IV database, 2998 critically ill patients with stroke requiring intensive care unit (ICU) admission were included. Patients were stratified into 8 groups based on the median of the TyG index and the quartiles of the SHR. The primary outcomes were 30-day and 365-day all-cause mortality; the secondary outcomes included 90-day and 180-day mortality. Cox proportional hazards regression models, restricted cubic splines (RCS) curves, subgroup analyses, and mediation analyses were employed to assess associations between the combined TyG index and SHR with all-cause mortality.
The cohort had a median age of 72.63 years (IQR 61.27-82.69 years), with 51.33% male (1539/2998). Fully adjusted Cox proportional hazards models showed that compared to the reference group (TyG < 8.72 and SHR < 0.86), patients with TyG ≥ 8.72 and SHR ≥ 1.18 had the highest mortality risk (30-day HR 2.481, 95% CI 1.767-3.485; 365-day HR 1.954, 95% CI 1.532-2.493). RCS analysis confirmed linear positive correlations between the TyG index, SHR, and mortality at all time points (all P for non-linearity > 0.05). Subgroup analyses further demonstrated consistent associations between the combined TyG index and SHR on 30-day and 365-day all-cause mortality. Mediation analysis revealed that the highest SHR significantly mediated the association between high TyG and mortality in these patients (30-day mediation proportion: 48.82%, P = 0.024; 365-day: 22.93%, P = 0.004).
The combination of high TyG (≥ 8.72) and elevated SHR (≥ 1.18) is significantly associated with increased short- and long-term mortality in critically ill patients with stroke. Integrated metabolic monitoring and early intervention targeting at these biomarkers may improve their prognosis.
甘油三酯-葡萄糖（TyG）指数和应激性高血糖比值（SHR）是脑血管疾病中新兴的生物标志物，但它们对重症卒中患者死亡率的联合预后价值仍未得到探索。本研究基于一组重症卒中患者队列，旨在探讨TyG指数和SHR联合在预测这一高危人群多个时间点全因死亡率方面的预后价值。
基于重症监护医学信息数据库（MIMIC）-IV，纳入2998例需要入住重症监护病房（ICU）的重症卒中患者。根据TyG指数的中位数和SHR的四分位数将患者分为8组。主要结局为30天和365天全因死亡率；次要结局包括90天和180天死亡率。采用Cox比例风险回归模型、限制立方样条（RCS）曲线、亚组分析和中介分析来评估TyG指数和SHR联合与全因死亡率之间的关联。
该队列的中位年龄为72.63岁（四分位间距61.27 - 82.69岁），男性占51.33%（1539/2998）。完全调整的Cox比例风险模型显示，与参照组（TyG＜8.72且SHR＜0.86）相比，TyG≥8.72且SHR≥1.18的患者死亡风险最高（30天风险比[HR] 2.481，95%置信区间[CI] 1.767 - 3.485；365天HR 1.954，95% CI 1.532 - 2.493）。RCS分析证实TyG指数、SHR与各时间点死亡率之间呈线性正相关（所有非线性P值均＞0.05）。亚组分析进一步表明TyG指数和SHR联合与30天和365天全因死亡率之间存在一致的关联。中介分析显示，最高的SHR显著介导了高TyG与这些患者死亡率之间的关联（30天中介比例：48.82%，P = 0.024；3一年：22.93%，P = 0.004）。
高TyG（≥8.72）和升高的SHR（≥1.18）联合与重症卒中患者的短期和长期死亡率增加显著相关。针对这些生物标志物进行综合代谢监测和早期干预可能改善其预后。
