U-shaped association between triglyceride-glucose index and all-cause mortality among critically ill pediatrics: a
Qi Gao1, Fan Luo1, Hongxue Yu1
1State Key Laboratory of Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Ave, Guangzhou, 510515, China.
Insights
The triglyceride-glucose (TyG) index shows a U-shaped association with mortality in critically ill children. An index below 8.6 is linked to lower mortality, while higher levels indicate increased risk.
Area of Science:
- Pediatric Intensive Care
- Metabolic Syndrome Research
- Clinical Prognostics
Background:
- Elevated triglyceride-glucose (TyG) index linked to mortality in adults.
- TyG index's association with prognosis in critically ill children is unknown.
Purpose of the Study:
- Investigate the TyG index's association with in-hospital mortality in critically ill pediatric patients.
- Determine the TyG index's predictive value for short-term outcomes in pediatric intensive care.
Main Methods:
- Analysis of 5706 patients from the Pediatric Intensive Care database.
- Utilized restricted cubic spline curves and Cox regression models.
- Assessed 30-day in-hospital and in-ICU all-cause mortality.
Main Results:
- A U-shaped association was observed between TyG index and mortality (P<0.001).
- TyG index < 8.6 correlated with reduced mortality risk.
- TyG index ≥ 8.6 was significantly associated with increased mortality risk.
Conclusions:
- The TyG index demonstrates a nonlinear, U-shaped relationship with mortality in critically ill children.
- A TyG index of 8.6 serves as a potential cutoff for predicting short-term mortality.
- The TyG index may be a valuable prognostic marker in pediatric intensive care.
Background:
Previous studies have shown that an elevated triglyceride-glucose (TyG) index was associated with all-cause mortality in both general adult individuals and critically ill adult patients. However, the relationship between the TyG index and clinical prognosis in pediatric patients admitted to the intensive care unit (ICU) remains unknown. We aimed to investigate the association of the TyG index with in-hospital all-cause mortality in critically ill pediatric patients.
Methods:
A total of 5706 patients in the Pediatric Intensive Care database were enrolled in this study. The primary outcome was 30-day in-hospital all-cause mortality, and secondary outcome was 30-day in-ICU all-cause mortality. The restricted cubic spline (RCS) curves and two-piecewise multivariate Cox hazard regression models were performed to explore the relationship between the TyG index and outcomes.
Results:
The median age of the study population was 20.5 [interquartile range (IQR): 4.8, 63.0] months, and 3269 (57.3%) of the patients were male. The mean TyG index level was 8.6 ± 0.7. A total of 244 (4.3%) patients died within 30 days of hospitalization during a median follow-up of 11 [7, 18] days, and 236 (4.1%) patients died in ICU within 30 days of hospitalization during a median follow-up of 6 [3, 11] days. The RCS curves indicated a U-shape association between the TyG index and 30-day in-hospital and in-ICU all-cause mortality (both P values for non-linear < 0.001). The risk of 30-day in-hospital all-cause mortality was negatively correlated with the TyG index until it bottoms out at 8.6 (adjusted hazard ratio [HR], 0.72, 95% confidence interval [CI] 0.55-0.93). However, when the TyG index was higher than 8.6, the risk of primary outcome increased significantly (adjusted HR, 1.51, 95% CI 1.16-1.96]). For 30-day in-ICU all-cause mortality, we also found a similar relationship (TyG < 8.6: adjusted HR, 0.75, 95% CI 0.57-0.98; TyG ≥ 8.6: adjusted HR, 1.42, 95% CI 1.08-1.85). Those results were consistent in subgroups and various sensitivity analysis.
Conclusions:
Our study showed that the association between the TyG index and 30-day in-hospital and in-ICU all-cause mortality was nonlinear U-shaped, with a cutoff point at the TyG index of 8.6 in critically ill pediatric patients. Our findings suggest that the TyG index may be a novel and important factor for the short-term clinical prognosis in pediatric patients.
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