Association of triglyceride glucose index with sepsis risk after major abdominal surgery: A retrospective cohort study.

Background & Objective: Recent studies have showed a correlation between hyperglycemia and insulin resistance with adverse outcomes in multiple critical diseases, including sepsis. The triglyceride-glucose index (TyGi) is now recognized as a proxy indicator of insulin therapy resistance. We aimed to ascertain the connection between TyGi and the sepsis prevalence and clinical outcomes in patient's post-abdominal surgery. Method: Data for this retrospective cohort study was acquired from the Medical Information Mart for Intensive Care IV database from 2008 to 2019. Patients (≥18 years) who had elective major abdominal surgery were included. The primary outcome was the occurrence of sepsis following abdominal surgery. The connection between TyGi and sepsis incidence was investigated with multivariable Cox regression analysis. Results: One thousand eight hundred eighty-four patients were included in this study. The cumulative incidence of sepsis during hospitalization was 12.3%. The adjusted Cox regression model showed that raised TyGi levels were linked to a greater probability of sepsis incidence (Hazard's ratio, 1.907; 95% CI, 1.327-2.739; p<0.001). Restricted Cubic Spline analysis demonstrated that TyGi possessed a strong and almost linear connection with the likelihood of postoperative sepsis. Subgroup analysis showed interaction effects in the subgroup with low high-density lipoprotein cholesterol (p for interaction=0.018). Furthermore, the incorporation of TyGi into the existing prediction model shows an enhancement in outcome prediction. The C-statistic elevated from 0.696 to 0.722, p<0.007. The continuous net reclassification improvement (NRI) was 0.203, p=0.005, and the integrated discrimination improvement (IDI) was 0.007, p<0.001. Conclusion: Patients at increased risk of developing sepsis following abdominal surgery may be identified in clinical practice with TyGi.