Liu Mengjiang, Yan Zhaodan, Zhang Yi, Zhang Shengli
Department of Endocrinology, Hubei NO.3 People's Hospital of Jianghan University, Wuhan, 430032, People's Republic of China.
Department of Cardiology, Hubei NO.3 People's Hospital of Jianghan University, Wuhan, 430032, People's Republic of China.
Diabetes Metab Syndr Obes. 2025 Aug 19;18:2923-2933. doi: 10.2147/DMSO.S539676. eCollection 2025.
This study aimed to explore the relationship between the triglyceride-glucose index (TyG) and all-cause mortality among patients with diabetes and chronic kidney disease (CKD).
This was a retrospective cohort study that included 512 patients with diabetes and CKD. The TyG index was considered the exposure factor, and patients were divided into three groups based on the tertiles of the TyG index. The association between the TyG index and all-cause mortality was evaluated using multivariate Cox regression analysis, subgroup analysis, sensitivity analysis, restricted cubic spline (RCS) plot, and receiver operating characteristic (ROC) curves.
Significant differences in clinical and metabolic parameters were observed across TyG tertiles, and all-cause mortality was markedly higher in the T3 group (P < 0.001). Multivariate Cox regression analysis showed that in the fully adjusted model (Model 3), the TyG index remained an independent risk factor, both as a continuous variable (HR = 1.582, 95% CI: 1.089-2.298, P = 0.016) and as a categorical variable (T3 vs T1, HR = 3.300, 95% CI: 1.820-5.984, P < 0.001). Subgroup analysis further confirmed consistent associations across various populations, including different age, sex, and comorbidity strata. Sensitivity analysis excluding patients with estimated glomerular filtration rate < 15 mL/min/1.73m showed robust associations in both continuous and categorical forms (P < 0.05). RCS analysis revealed a significant nonlinear relationship between Log-transformed TyG index and all-cause mortality (P-nonlinear < 0.001). ROC curve analysis demonstrated that the TyG index alone had better predictive ability for all-cause mortality (AUC = 0.690) than age, hemoglobin A1c, or total cholesterol. The baseline model had an AUC of 0.809, which increased significantly to 0.878 (95% CI: 0.846-0.911) when the TyG index was added.
The TyG index was independently and nonlinearly associated with all-cause mortality in patients with diabetes and CKD. These findings suggest that the TyG index may serve as a useful, non-invasive biomarker for risk stratification and mortality prediction in this high-risk population, with potential clinical implications for improving long-term management and prognosis.
本研究旨在探讨糖尿病合并慢性肾脏病（CKD）患者的甘油三酯-葡萄糖指数（TyG）与全因死亡率之间的关系。
这是一项回顾性队列研究，纳入了512例糖尿病合并CKD患者。将TyG指数视为暴露因素，根据TyG指数的三分位数将患者分为三组。采用多因素Cox回归分析、亚组分析、敏感性分析、限制性立方样条（RCS）图和受试者工作特征（ROC）曲线评估TyG指数与全因死亡率之间的关联。
在TyG三分位数之间观察到临床和代谢参数存在显著差异，T3组的全因死亡率明显更高（P < 0.001）。多因素Cox回归分析显示，在完全调整模型（模型3）中，TyG指数无论是作为连续变量（HR = 1.582，95%CI：1.089 - 2.298，P = 0.016）还是分类变量（T3与T1相比，HR = 3.300，95%CI：1.820 - 5.984，P < 0.001），仍然是一个独立的危险因素。亚组分析进一步证实了在不同人群中，包括不同年龄、性别和合并症分层，存在一致的关联。排除估计肾小球滤过率<15 mL/min/1.73m²的患者进行敏感性分析，显示在连续和分类形式下均有稳健的关联（P < 0.05）。RCS分析显示，对数转换后的TyG指数与全因死亡率之间存在显著的非线性关系（P-非线性 < 0.001）。ROC曲线分析表明，单独的TyG指数对全因死亡率的预测能力（AUC = 0.690）优于年龄、糖化血红蛋白或总胆固醇。基线模型的AUC为0.809，当加入TyG指数时，显著增加到0.878（95%CI：0.846 - 0.911）。
TyG指数与糖尿病合并CKD患者的全因死亡率独立且呈非线性相关。这些发现表明，TyG指数可能作为一种有用的、非侵入性的生物标志物，用于该高危人群的风险分层和死亡率预测，对改善长期管理和预后具有潜在的临床意义。
