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Background <p>Several studies have indicated that several million cardiac surgeries are performed worldwide each year. Recognized for reflecting insulin resistance, the triglyceride glucose-body mass index (TyG-BMI) index has been demonstrated a strong association with the incidence of cardiovascular events. Although the TyG-BMI index has been extensively investigated in the context of metabolic disorders, its prognostic value in patients undergoing cardiac surgery remains insufficiently defined. The study investigated whether TyG-BMI at Intensive Care Unit (ICU) admission predicts all-cause mortality in critically ill post–cardiac surgery patients.</p> Method <p>Patient records of individuals who had undergone cardiac surgery were obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, a comprehensive source of critical care data. Based on their TyG-BMI values, patients were stratified into four distinct categories. This study focused on all-cause mortality at 30 and 365 days as the main outcomes, while 90- and 180-day mortality were treated as secondary measures. To assess differences in clinical outcomes, subjects were grouped into TyG-BMI quartiles, and corresponding Kaplan–Meier(KM) curves were constructed. Additionally, the relationship between the TyG-BMI index and the study outcomes was assessed using Cox proportional-hazards regression and restricted cubic splines (RCS).</p> Results <p>The study cohort comprised 2,624 critically ill patients following cardiac surgery, with a mean age of 66.54 ± 11.28 years; males accounted for 73.17% (<i>n</i> = 1,920). Stratification of patients into TyG-BMI quartiles revealed marked differences in all-cause mortality at 30-, 90-, 180-, and 365-day follow-up intervals. Interestingly, as the TyG-BMI index increased, survival rates at 30, 90, 180, and 365 days did not follow a consistently upward trend, but rather showed an initial improvement followed by a gradual decline. However, following the decline, the survival rate was similar to that observed in patients exhibiting the lowest range of TyG-BMI. A nonlinear U-shaped relationship was observed linking TyG-BMI levels with mortality over the 30- to 365-day period, as shown by spline-based modeling. The inflection points for these relationships were 235.7, 238.25, 238.2, and 238.25, respectively. The results from the Cox regression analysis matched up with what we found using the RCS analysis.</p> Conclusion <p>In critically ill patients following cardiac surgery, the TyG-BMI index exhibited a U-shaped association with all-cause mortality at 30, 90, 180, and 365 days. The TyG-BMI index could be a useful tool for evaluating and managing patients in the ICU following cardiac surgery.</p>

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The association between triglyceride glucose–body mass index and all–cause mortality in critically ill patients undergoing cardiac surgery: a retrospective analysis from the MIMIC–IV database

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  • 发表日期：

    2025年10月27日

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  • Yuanfang Jia,
  • Junwei Zhang,
  • Lei Zhang,
  • Aijie Liu

摘要

Background

Several studies have indicated that several million cardiac surgeries are performed worldwide each year. Recognized for reflecting insulin resistance, the triglyceride glucose-body mass index (TyG-BMI) index has been demonstrated a strong association with the incidence of cardiovascular events. Although the TyG-BMI index has been extensively investigated in the context of metabolic disorders, its prognostic value in patients undergoing cardiac surgery remains insufficiently defined. The study investigated whether TyG-BMI at Intensive Care Unit (ICU) admission predicts all-cause mortality in critically ill post–cardiac surgery patients.

Method

Patient records of individuals who had undergone cardiac surgery were obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, a comprehensive source of critical care data. Based on their TyG-BMI values, patients were stratified into four distinct categories. This study focused on all-cause mortality at 30 and 365 days as the main outcomes, while 90- and 180-day mortality were treated as secondary measures. To assess differences in clinical outcomes, subjects were grouped into TyG-BMI quartiles, and corresponding Kaplan–Meier(KM) curves were constructed. Additionally, the relationship between the TyG-BMI index and the study outcomes was assessed using Cox proportional-hazards regression and restricted cubic splines (RCS).

Results

The study cohort comprised 2,624 critically ill patients following cardiac surgery, with a mean age of 66.54 ± 11.28 years; males accounted for 73.17% (n = 1,920). Stratification of patients into TyG-BMI quartiles revealed marked differences in all-cause mortality at 30-, 90-, 180-, and 365-day follow-up intervals. Interestingly, as the TyG-BMI index increased, survival rates at 30, 90, 180, and 365 days did not follow a consistently upward trend, but rather showed an initial improvement followed by a gradual decline. However, following the decline, the survival rate was similar to that observed in patients exhibiting the lowest range of TyG-BMI. A nonlinear U-shaped relationship was observed linking TyG-BMI levels with mortality over the 30- to 365-day period, as shown by spline-based modeling. The inflection points for these relationships were 235.7, 238.25, 238.2, and 238.25, respectively. The results from the Cox regression analysis matched up with what we found using the RCS analysis.

Conclusion

In critically ill patients following cardiac surgery, the TyG-BMI index exhibited a U-shaped association with all-cause mortality at 30, 90, 180, and 365 days. The TyG-BMI index could be a useful tool for evaluating and managing patients in the ICU following cardiac surgery.