What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation in critically ill patients (n=1142). Intervention: Elevated triglyceride-glucose (TyG) index vs. Lowest tertile of triglyceride-glucose (TyG) index. Primary outcome: Acute kidney injury (AKI) (OR 1.37, 95% CI 1.29-2.02, p=0.02).

September 29, 2025BMC Cardiovascular Disorders2 citationsOpen Access

Elevated triglyceride-glucose index and acute kidney injury risk in critical atrial fibrillation: an analysis from MIMIC-IV

YLYe Lu YWYifan Wu YWYifan Wu

Key Result

An elevated triglyceride-glucose index independently predicted a higher risk of acute kidney injury in critically ill patients with atrial fibrillation, with the highest tertile showing an OR of 1.37 compared to the lowest.

Study Design

Type

Cohort (n=1,142)

Multicenter

Structured PICO

Does an elevated triglyceride-glucose (TyG) index predict acute kidney injury in critically ill patients with atrial fibrillation?

Population

1,142 critically ill adults with atrial fibrillation admitted to the ICU, evaluated for the association between the triglyceride-glucose index and acute kidney injury.

Exposure

Elevated triglyceride-glucose (TyG) index (highest tertile)

Comparator

Lower triglyceride-glucose (TyG) index (middle and lowest tertiles)

Outcome

Acute kidney injury (AKI)hard clinical

An elevated triglyceride-glucose index independently predicts a higher risk of acute kidney injury in critically ill patients with atrial fibrillation, offering a potential tool for risk stratification.

Main Result

Odds Ratio: 1.37 (95% CI 1.29–2.02)

Absolute Event Rate: 52.76% vs 36.39%

p-value: p=0.02

Limitations

Retrospective observational design limits the ability to establish causality.
Potential residual confounding from unmeasured variables.
Possible overadjustment due to variables like ACEI/ARB or vasoactive agent use being on the causal pathway.
Single-center database (MIMIC-IV) limits generalizability to other settings.
Lack of data on long-term renal outcomes beyond the hospital stay.

Abstract

BACKGROUND: Atrial fibrillation (AF) is common in intensive care and often complicated by acute kidney injury (AKI). The triglyceride-glucose (TyG) index, a marker of insulin resistance, has not been studied for AKI risk in AF patients. METHODS: This retrospective cohort study analyzed 1,142 critically ill AF patients from MIMIC-IV. Patients were stratified by TyG index tertiles. Multivariable logistic regression, restricted cubic splines, and ROC curves assessed the TyG-AKI relationship, adjusting for confounders. RESULTS: AKI incidence was highest in the top TyG tertile (52.76%) versus middle (37.20%) and lowest (36.39%) (p < 0.001). After adjustment, higher TyG (continuous) correlated with increased AKI risk (OR 1.21, 95% CI 1.02-1.45, p = 0.002). The highest tertile had greater AKI risk than the lowest (OR 1.37, 95% CI 1.29-2.02, p = 0.02). Spline analysis showed a near-linear dose-response relationship. The ROC AUC was 0.77, indicating moderate predictive value. Subgroup analyses confirmed consistency across age, sex, ethnicity, and comorbidities. CONCLUSION: Elevated TyG index independently predicts higher AKI risk in critically ill AF patients, with a near-linear association. The TyG index may aid AKI risk stratification in this population.

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