背景:先前的研究表明,在一般成人个体和危重成人患者中,甘油三酯-葡萄糖(TyG)指数升高与全因死亡率相关。然而,在入住重症监护病房(ICU)的儿科患者中,TyG指数与临床预后之间的关系尚不清楚.我们旨在调查TyG指数与危重儿科患者院内全因死亡率的关系。
方法:本研究纳入儿科重症监护数据库中的5706名患者。主要结果是30天住院全因死亡率,次要结局是ICU内30天全因死亡率.使用受限三次样条(RCS)曲线和两分段多变量Cox风险回归模型来探索TyG指数与结果之间的关系。
结果:研究人群的中位年龄为20.5[四分位距(IQR):4.8,63.0]个月,3269例(57.3%)患者为男性。平均TyG指数水平为8.6±0.7。共有244名(4.3%)患者在住院后30天内死亡,中位随访时间为11[7,18]天,236例(4.1%)患者在住院后30天内在ICU死亡,中位随访时间为6[3,11]天.RCS曲线表明TyG指数与30天住院和ICU全因死亡率呈U型相关(非线性P值均<0.001)。30天住院全因死亡率的风险与TyG指数呈负相关,直到其在8.6时达到最低点(调整后的风险比[HR],0.72,95%置信区间[CI]0.55-0.93)。然而,当TyG指数高于8.6时,主要结局的风险显着增加(调整后的HR,1.51,95%CI1.16-1.96])。对于ICU内30天的全因死亡率,我们还发现了类似的关系(TyG<8.6:调整后的HR,0.75,95%CI0.57-0.98;TyG≥8.6:调整后的HR,1.42,95%CI1.08-1.85)。这些结果在亚组和各种敏感性分析中是一致的。
结论:我们的研究表明,TyG指数与30天住院和ICU全因死亡率之间的关系呈非线性U形,危重儿科患者的TyG指数截止点为8.6。我们的发现表明,TyG指数可能是儿科患者短期临床预后的新的重要因素。
BACKGROUND: Previous studies have shown that an elevated triglyceride-glucose (TyG) index was associated with all-cause mortality in both general adult individuals and critically ill adult patients. However, the relationship between the TyG index and clinical prognosis in pediatric patients admitted to the intensive care unit (ICU) remains unknown. We aimed to investigate the association of the TyG index with in-hospital all-cause mortality in critically ill pediatric patients.
METHODS: A total of 5706 patients in the Pediatric Intensive Care database were enrolled in this study. The primary outcome was 30-day in-hospital all-cause mortality, and secondary outcome was 30-day in-ICU all-cause mortality. The restricted cubic spline (RCS) curves and two-piecewise multivariate Cox hazard regression models were performed to explore the relationship between the TyG index and outcomes.
RESULTS: The median age of the study population was 20.5 [interquartile range (IQR): 4.8, 63.0] months, and 3269 (57.3%) of the patients were male. The mean TyG index level was 8.6 ± 0.7. A total of 244 (4.3%) patients died within 30 days of hospitalization during a median follow-up of 11 [7, 18] days, and 236 (4.1%) patients died in ICU within 30 days of hospitalization during a median follow-up of 6 [3, 11] days. The RCS curves indicated a U-shape association between the TyG index and 30-day in-hospital and in-ICU all-cause mortality (both P values for non-linear < 0.001). The risk of 30-day in-hospital all-cause mortality was negatively correlated with the TyG index until it bottoms out at 8.6 (adjusted hazard ratio [HR], 0.72, 95% confidence interval [CI] 0.55-0.93). However, when the TyG index was higher than 8.6, the risk of primary outcome increased significantly (adjusted HR, 1.51, 95% CI 1.16-1.96]). For 30-day in-ICU all-cause mortality, we also found a similar relationship (TyG < 8.6: adjusted HR, 0.75, 95% CI 0.57-0.98; TyG ≥ 8.6: adjusted HR, 1.42, 95% CI 1.08-1.85). Those results were consistent in subgroups and various sensitivity analysis.
CONCLUSIONS: Our study showed that the association between the TyG index and 30-day in-hospital and in-ICU all-cause mortality was nonlinear U-shaped, with a cutoff point at the TyG index of 8.6 in critically ill pediatric patients. Our findings suggest that the TyG index may be a novel and important factor for the short-term clinical prognosis in pediatric patients.