ArticleEuropean journal of medical research2026
Association of triglyceride glucose index with mortality in critically ill patients with atherosclerotic cardiovascular disease: analysis of the MIMIC-IV database.
Article in European journal of medical research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Independent prognostic value of the triglyceride-glucose index and its incremental predictive contribution beyond traditional risk markers in acute heart failure: a retrospective cohort study.Frontiers in cardiovascular medicine · 2026Article
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4 authors.
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Abstract
backgroundThe triglyceride glucose (TyG) index, a surrogate marker of insulin resistance, has been linked to cardiovascular risk. However, its prognostic role in critically ill patients with atherosclerotic cardiovascular disease (ASCVD) remains unclear.
methodsIn this retrospective cohort study using the MIMIC-IV database, we identified 2,493 ASCVD patients and stratified them into TyG tertiles upon Intensive Care Unit (ICU) admission. Primary outcomes were 30-, 90-, and 365-day mortality. Secondary outcomes included the use and timing of mechanical ventilation (MV) and vasopressors. Cox regression, restricted cubic spline, and Fine-Gray competing risk models were applied. Propensity score matching (PSM) was performed as a sensitivity analysis. Subgroup analyses were conducted by age, sex, race, hypertension, diabetes, and statin use. Mediation analysis using white blood cell (WBC) count explored systemic inflammation.
resultsHigher TyG tertiles were consistently associated with increased mortality: 30-day (HR 1.85, 95% CI 1.46-2.36, P < 0.001), 90-day (HR 1.73, 95% CI 1.39-2.15, P < 0.001), and 365-day (HR 1.66, 95% CI 1.37-2.03, P < 0.001). These associations remained robust in propensity score-matched (PSM) analyses. Elevated TyG was also linked to greater need for MV (OR 1.93, 95% CI 1.66-2.24, P < 0.001) and vasopressor support (OR 1.58, 95% CI 1.35-1.86, P < 0.001) within the first 24 h, and to earlier initiation of these interventions in competing risk models (MV): sHR (subdistribution hazard ratio) 1.46, 95% CI 1.35-1.57, P < 0.001; vasopressor use: sHR 1.41, 95% CI 1.30-1.53, P < 0.001. WBC count partially mediated the TyG-mortality association, accounting for 22.18% of the total effect (P < 0.001) for 30-day mortality. In exploratory subgroup analyses, the association between TyG and mortality appeared more pronounced in nondiabetic patients (30-day HR 1.58, 95% CI 1.35-1.84) than in diabetic patients (HR 1.13, 95% CI 0.94-1.36), although these findings should be interpreted cautiously.
conclusionIn critically ill patients with ASCVD, higher TyG index was associated with adverse outcomes, including increased mortality and earlier initiation of organ-supportive interventions. These findings suggest that TyG could serve as a practical biomarker for early risk stratification in this high-risk population, though prospective studies are warranted to confirm its clinical utility.
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