Triglyceride-Glucose Index and Prognosis in Non-Diabetic critically ill Patients: data from the eICU Database

Li Xi ¹ Lin Qiujin ² Dewen Zhang ³ Zhenhua Huang ⁴ Yu Jinshi ¹ Zhao Jiaqi ¹ Wenzhou Li ^5* Liu Wei ^6*

• ¹ Pharmacy Department, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
• ² Department of Critical Care Medicine, Pengpai Memorial Hospital, Shanwei, China
• ³ Department of Pharmacy, Pengpai Memorial Hospital, Shanwei, China
• ⁴ Department of Emergency Medicine, the First Affiliated Hospital of Shenzhen University &Shenzhen Second People’s Hospital, Shenzhen, China
• ⁵ Baoan Women's and Children's Hospital, Shenzhen, Guangdong, China
• ⁶ Department of Emergency Medicine, Huangpu People's Hospital, Zhongshan, Guangdong Province, China

The triglyceride-glucose (TyG) index is a marker for insulin resistance (IR) linked to diabetes complications and poor outcomes. Its connection to all-cause mortality in non-diabetic critically ill patients is unknown. This study aims to investigate the TyG index's impact on mortality in this population, evaluating how IR affects their prognosis.Methods: This study is retrospective observational research utilizing data from the eICU Collaborative Research Database. A total of 14,089 non-diabetic critically ill patients were included and categorized into three groups based on the TyG index measured on the first day of admission (T1, T2, T3). Kaplan-Meier survival analysis was performed to compare the 28day mortality rates among the different groups. Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Additionally, we conducted sensitivity analyses, subgroup analyses, and interaction analyses to assess the robustness of the results.Results: During the observation period, 730 patients (5.18%) died in the ICU, while 1,178 patients (8.36%) died in the hospital. The 28-day ICU mortality rate and hospital mortality rate significantly increased with higher TyG index values (P < 0.001). Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality.Specifically, Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Furthermore, the analysis showed a nonlinear effect of the TyG index on mortality in non-diabetic critically ill patients, with a critical point at 9.94. While Below 9.94, ICU and hospital mortality rates rose with higher TyG index values. But above 9.94, mortality didn't significantly increase despite further rises in the TyG index. Sensitivity and subgroup analyses confirmed the robustness of these results, and E-value analysis indicated strong resistance to unmeasured confounding factors.The TyG index demonstrates a significant positive correlation with all-cause mortality in non-diabetic critically ill patients, exhibiting a nonlinear relationship.Consequently, the TyG index serves as a crucial tool for identifying high-risk patients, thereby assisting clinicians in formulating more effective monitoring and intervention strategies.