Association of triglyceride-glucose index fluctuation with in-hospital all-cause mortality in critically ill patients: a multidatabase retrospective study

Figures

• 

  Fig. 1. The flowchart of study participants.

• 

  Fig. 2. Associations of TyG metrics with in-hospital all-cause mortality in the MIMIC and SWH cohorts. Top panel: MIMIC; bottom panel: SWH. Points show odds ratios (ORs) with 95% CIs for the association between each continuous TyG metric and in-hospital all-cause death; the x-axis is on a log scale. Metrics: TyG_BL (Baseline, first TyG after ICU admission), TyG_Median, TyG_ Average, TyG_Range (max–min), TyG_SD (standard deviation), and TyG_CV (coefficient of variation, SD/mean). Models were fit separately within each cohort: Model 1, unadjusted; Model 2, adjusted for age, sex, BMI; Model 3, further adjusted for clinical/laboratory covariates per Methods-SOFA (MIMIC only), hemoglobin, platelet count, RBC, RDW (MIMIC only), WBC, NLR, albumin, bicarbonate (MIMIC only), creatinine, sodium, calcium, potassium, PT, PTT, ALT, ALP, AST, LDH, and lipids (LDL/HDL in SWH). P values are from two-sided Wald tests. An OR > 1 indicates higher mortality risk with increasing values of the corresponding TyG metric. Abbreviations: TyG, triglyceride–glucose index; ICU, intensive care unit; SD, standard deviation; CV, coefficient of variation.

• 

  Fig. 3. Kaplan–Meier cumulative incidence of in-hospital all-cause mortality across tertiles of TyG metrics in the MIMIC and SWH cohorts. (A–F) MIMIC; (G–L): SWH. Metrics by panel—A/G: TyG Baseline (first value after ICU admission); B/H: TyG Average; C/I: TyG Median; D/J: TyG STD; E/K: TyG Range (max − min); F/L: TyG CV. Curves compare Group 1 (lowest tertile), Group 2 (middle tertile), and Group 3 (highest tertile) for each TyG metric: Baseline (first TyG after ICU admission), Mean (Average), Median, SD (standard deviation), Range (max − min), and CV (SD/mean). The outcome is in-hospital all-cause death; the y-axis shows cumulative incidence = 1 − S(t), time is in days from ICU admission, and observations are censored at hospital discharge. P-values are from two-sided log-rank tests without covariate adjustment. Tertile cut-points were defined separately within each dataset. Abbreviations: TyG, triglyceride–glucose index; SD, standard deviation; CV, coefficient of variation; KM, Kaplan–Meier.

• 

  Fig. 4. Restricted cubic spline relationships between TyG metrics and in-hospital all-cause mortality in the MIMIC and SWH cohorts. (A–F) MIMIC; (G–L) SWH. Metrics by panel-A/G: TyG Baseline (first value after ICU admission); B/H: TyG Average; C/I: TyG Median; D/J: TyG STD; E/K: TyG Range (max–min); F/L: TyG CV. Curves display adjusted odds ratios (OR) from multivariable logistic regression with restricted cubic splines; ribbons indicate 95% CIs. The reference is the cohort-specific median of each TyG metric. Knots were placed at the 5th, 35th, 65th, and 95th percentiles (Harrell’s recommendation). P for overall tests the overall association; P for nonlinearity tests deviation from linearity (two-sided). Background histograms show the empirical distribution of each TyG metric (right y-axis = density). Models were fit separately in each cohort and adjusted as in Model 3 (age, sex, BMI, and prespecified clinical/laboratory covariates; SOFA, RDW, and bicarbonate available in MIMIC only). Abbreviations: TyG, triglyceride–glucose index; SD, standard deviation; CV, coefficient of variation; ICU, intensive care unit.