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Background <p>The 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.</p> Methods <p>In 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.</p> Results <p>Higher TyG tertiles were consistently associated with increased mortality: 30-day (HR 1.85, 95% CI 1.46–2.36, <i>P</i> &lt; 0.001), 90-day (HR 1.73, 95% CI 1.39–2.15, <i>P</i> &lt; 0.001), and 365-day (HR 1.66, 95% CI 1.37–2.03, <i>P</i> &lt; 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, <i>P</i> &lt; 0.001) and vasopressor support (OR 1.58, 95% CI 1.35–1.86, <i>P</i> &lt; 0.001) within the first 24&#xa0;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, <i>P</i> &lt; 0.001; vasopressor use: sHR 1.41, 95% CI 1.30–1.53, <i>P</i> &lt; 0.001. WBC count partially mediated the TyG-mortality association, accounting for 22.18% of the total effect (<i>P</i> &lt; 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.</p> Conclusion <p>In 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.</p> Graphical Abstract <p></p>

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Association of triglyceride glucose index with mortality in critically ill patients with atherosclerotic cardiovascular disease: analysis of the MIMIC-IV database

  • 期刊论文

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  • 发表日期：

    2026年2月5日

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  • Huibo Wang,
  • Guosong Jiang,
  • Xiaoxiao Qu,
  • Jinmeng Zhou

摘要

Background

The 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.

Methods

In 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.

Results

Higher 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.

Conclusion

In 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.

Graphical Abstract