Photo Credit: Mr. Suphachai Praserdumrongchai
The following is a summary of the “Triglyceride-glucose index: a novel evaluation tool for all-cause mortality in critically ill hemorrhagic stroke patients retrospective analysis of the MIMIC-IV database,” published in the March 2024 issue of Cardiology by Huang et al.
Hemorrhagic stroke (HS), encompassing non-traumatic intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), constitutes a significant portion of cerebrovascular events, comprising approximately 30% of stroke incidents. The triglyceride-glucose index (TyG-i), serving as a precise indicator of insulin resistance (IR), presents a pivotal metabolic disturbance. While existing literature has established an association between TyG-i and all-cause mortality (ACM) in patients with ischemic stroke (IS), its prognostic implications for critically ill patients with HS necessitating intensive care unit (ICU) admission remain unclear. Given the substantially elevated mortality and morbidity associated with HS compared to IS, investigating this association is imperative. Their primary objective was to explore the relationship between TyG-i and ACM among critically ill patients with HS in the ICU setting.
Critically ill patients with HS were identified using the Medical Information Mart for Intensive Care-IV (MIMIC-IV, version 2.2) database, employing the International Classification of Diseases (ICD)-9/10 diagnostic guidelines. Subsequently, patients were stratified into quartiles based on their TyG-i scores, and mortality outcomes were assessed at ICU admission, in-hospital, 30 days, 90 days, and 1 year. Cox proportional hazards regression analysis and restricted cubic splines (RCS) were utilized to elucidate the TyG-i and ACM relationship, while survival curves were estimated using the Kaplan-Meier (K-M) method. The robustness of the findings was evaluated through subgroup analysis and interaction tests using likelihood ratio tests.
The analysis comprised 1,475 patients, with a male predominance of 54.4%. Mortality rates observed in the ICU, hospital, at 30 days, 90 days, and 1 year were 7.3%, 10.9%, 13.8%, 19.7%, and 27.3%, respectively. Multivariate Cox regression analysis revealed a significant association between elevated TyG-i levels and ACM at 30 days (adjusted hazard ratio [aHR]: 1.32; 95% confidence interval [CI]: 1.05–1.67; P = 0.020), 90 days (aHR: 1.27; 95% CI: 1.04–1.55; P = 0.019), and 1 year (aHR: 1.22; 95% CI: 1.03–1.44; P = 0.023). RCS analysis demonstrated a progressive increase in ACM risk with rising TyG-i levels, with no significant effect modification observed in interaction tests.
In conclusion, TyG-i is significantly correlated with ACM in critically ill patients with HS, suggesting its potential utility as a prognostic tool for risk stratification in this population. Incorporating TyG-i into clinical practice may enhance therapeutic decision-making and disease management. Furthermore, this study contributes to the existing body of research on TyG-i’s role in predicting mortality across various stroke categories, shedding light on its broader clinical implications.
Source: cardiab.biomedcentral.com/articles/10.1186/s12933-024-02193-3