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May 30, 2026BMC Cardiovascular DisordersOpen Access

Association between triglyceride glucose-body mass index and all-cause mortality in critically ill patients with atherosclerotic cardiovascular diseases: a retrospective cohort study using the MIMIC-IV database

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Key result

Elevated TyG-BMI linked to ~89% lower 30-day mortality in critically ill ASCVD patients.

HR 0.11
95% CI 0.06-0.19
P<0.001
n=1,637

Why the study?

While the triglyceride glucose-body mass index has emerged as a promising insulin resistance marker, its prognostic value for ASCVD mortality outcomes required further elucidation.

Does the triglyceride glucose-body mass index (TyG-BMI) predict mortality in critically ill patients with atherosclerotic cardiovascular diseases?

Key Points

To assess the prognostic value and dose-response relationship of the triglyceride glucose-body mass index (TyG-BMI) for short- and long-term all-cause mortality in critically ill patients with atherosclerotic cardiovascular disease.
Retrospective cohort study analyzing 1,637 critically ill patients with atherosclerotic cardiovascular disease (median age 68.3 years) from the MIMIC-IV database.
Patients were divided into TyG-BMI quartiles (Q1: <297.3, Q2: 297.3-337.4, Q3: 337.4-433.1, Q4: >433.1) and evaluated for 30-day, 90-day, 180-day, and 1-year mortality.
Multivariable Cox proportional hazards regression, restricted cubic splines for nonlinearity, Kaplan-Meier analysis, and ROC curve enhancements over conventional ICU risk scores were evaluated.
After full adjustment, patients in the highest quartile (Q4) had significantly lower 30-day mortality (HR 0.11, 95% CI 0.06–0.19) and 1-year mortality (HR 0.13, 95% CI 0.08–0.20) compared with Q1 (both P-trend < 0.001).
Restricted cubic splines showed an L-shaped dose-response curve (nonlinear P < 0.001) with inflection points at 449.3 for 30-day and 448.8 for 1-year mortality; risk decreased before the threshold (HR 0.988, 95% CI 0.986–0.989 and HR 0.989, 95% CI 0.987–0.990, respectively; both P < 0.001) and slightly increased above it.
Adding TyG-BMI significantly improved discriminative performance of SOFA, SAPS II, APS III, and OASIS scoring models for 30-day and 1-year mortality (all P < 0.001).

Study Design

Type

Cohort (n=1,637)

Multicenter

No

Structured PICO

Does the triglyceride glucose-body mass index (TyG-BMI) predict mortality in critically ill patients with atherosclerotic cardiovascular diseases?

P

Population

1,637 critically ill patients with atherosclerotic cardiovascular diseases (ASCVD), median age 68.3 years

I

Intervention

Triglyceride glucose-body mass index (TyG-BMI) assessment

C

Comparator

Lower TyG-BMI levels (quartile comparison)

O

Outcome

30-day and 1-year mortalityhard clinical

Main Result

Effect estimate: HR 0.11 (95% CI 0.06-0.19)

p-value: p=<0.001

Elevated TyG-BMI is an independent predictor of improved survival in critically ill ASCVD patients, demonstrating a distinct nonlinear protective effect.

Limitations

Retrospective observational design using the MIMIC-IV database

Implication

High TyG-BMI associated with lower 30-day mortality in critical ASCVD; hypothesis-generating and should not yet change practice.

Abstract

Background Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of cardiovascular mortality worldwide, with insulin resistance recognized as a key pathophysiological driver. While the triglyceride glucose-body mass index (TyG-BMI) has emerged as a promising insulin resistance marker, its prognostic value for ASCVD mortality outcomes requires further elucidation. Methods We conducted a retrospective cohort study of 1,637 critically ill ASCVD patients (median age 68.3 years) from the MIMIC-IV database. The primary endpoints were 30-day and 1-year mortality, with secondary assessments of 90-day and 180-day mortality. Comprehensive statistical analyses included multivariable Cox regression, restricted cubic splines (RCSs) for nonlinearity assessment, and Kaplan-Meier survival analysis. Results After full adjustment for potential confounders, elevated TyG-BMI showed significant inverse associations with both 30-day (HR 0.11, 95% CI 0.06–0.19) and 1-year mortality (HR 0.13, 95% CI 0.08–0.20). RCS analysis revealed a characteristic L-shaped dose-response relationship (nonlinear P < 0.001), while Kaplan-Meier curves demonstrated progressively improved survival across TyG-BMI quartiles (log-rank P < 0.001). Conclusion This study revealed that the TyG-BMI is an independent predictor of mortality in critically ill ASCVD patients, with a distinct nonlinear protective effect. These findings support the potential clinical utility of the TyG-BMI for risk stratification in this high-risk population.

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Published by BMC Cardiovascular Disorders · CC BY

Cite This Study

Liu et al. (2026) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) (n=1,637). Elevated Triglyceride glucose-body mass index (TyG-BMI) vs. Quartile 1 (<297.3) was evaluated on 30-day mortality (HR 0.11, 95% CI 0.06-0.19, p=<0.001). Elevated triglyceride glucose-body mass index (highest quartile) was significantly associated with reduced 30-day mortality (HR 0.11) compared to the lowest quartile in critically ill ASCVD patients.

synapsesocial.com/papers/6a1a814b0307b785094331d2 https://doi.org/10.1186/s12872-026-06022-1

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