Combined impact of triglyceride–glucose index and clinically significant anemia on acute kidney injury risk in critically ill patients

Background Early prediction of acute kidney injury (AKI) in the ICU remains challenging due to the limitations of traditional markers. This study evaluated the admission triglyceride–glucose (TyG) index a surrogate for insulin resistance, and anemia as significant predictors of AKI in ICU patients. Patients and methods A prospective cohort study of 200 ICU patients was conducted. The admission TyG index was calculated from routine laboratory data. In our study, clinically significant anemia is defined as Hb level less than 10 g/dl in ICU patients. AKI was defined per KDIGO criteria within the first 7 days of admission. Statistical performance has been evaluated using receiver operating characteristic (ROC) curves and multivariable logistic regression analysis. Results AKI occurred in 33.5% of patients. Those with AKI had a significantly higher TyG index (9.7 ± 0.4 vs. 9.2 ± 0.4, P <0.001) and a higher prevalence of anemia (59.7 vs. 24.8%, P <0.001). In multivariable analysis, both the TyG index (adjusted odds ratios: 18.87; 95% confidence interval: 3.05–101.67) and anemia (adjusted odds ratios: 5.18; 95% confidence interval: 2.21–12.14) were strong independent predictors of AKI ( P <0.001). Individually, the TyG index and anemia showed area under the curves of 0.790 and 0.674, respectively. However, the combined model yielded the highest diagnostic accuracy (area under the curve: 0.827), significantly enhancing specificity to 89.5%. Conclusion Admission TyG index and clinically significant anemia are potent independent predictors of AKI in critically ill patients. While both markers show fair individual discriminative ability, their integration provides a superior, high-specificity tool for early risk stratification in the ICU.