Association between triglyceride-glucose index and AKI in ICU patients based on MIMICIV database: a cross-sectional study

Figures & data

Figure 1. Flowchart of the study cohort.

Table 1. Baseline characteristics of critical patients grouped according to TyG index quartiles.^a

Categories	Total (n = 54,263)	Q1 (n = 13,555)	Q2 (n = 13,565)	Q3 (n = 13,576)	Q4 (n = 13,567)	p value
Gender						< 0.001
Female	28,123 (51.8)	7969 (58.8)	7240 (53.4)	6837 (50.4)	6077 (44.8)
Male	26,140 (48.2)	5586 (41.2)	6325 (46.6)	6739 (49.6)	7490 (55.2)
Age	59.3 ± 17.7	56.1 ± 19.5	60.3 ± 18.0	61.1 ± 16.7	59.6 ± 15.9	< 0.001
Race, n (%)						< 0.001
Asia	2735 (5.0)	564 (4.2)	674 (5)	688 (5.1)	809 (6)
Black	9217 (17.0)	2958 (21.8)	2282 (16.8)	2071 (15.3)	1906 (14)
Latino	3489 (6.4)	741 (5.5)	781 (5.8)	864 (6.4)	1103 (8.1)
White	35,104 (64.7)	8508 (62.8)	8962 (66.1)	9015 (66.4)	8619 (63.5)
Other	3718 (6.9)	784 (5.8)	866 (6.4)	938 (6.9)	1130 (8.3)
Laboratory tests
Glucose, mmol/l	5.7 (5.0, 7.1)	5.1 (4.6, 5.6)	5.4 (4.9, 6.3)	5.9 (5.2, 7.2)	7.8 (5.9, 11.3)	< 0.001
Triglycerides, mmol/l	6.3 (4.4, 9.3)	3.7 (3.0, 4.3)	5.6 (4.8, 6.4)	7.9 (6.6, 9.3)	12.3 (9.2, 16.3)	< 0.001
Hemoglobin, g/dl	13.1 ± 1.9	13.0 ± 1.8	13.1 ± 1.9	13.2 ± 1.9	13.2 ± 2.0	< 0.001
Lymphocytes, %	23.6 ± 11.9	24.8 ± 11.9	23.7 ± 11.6	23.1 ± 12.0	22.6 ± 12.1	< 0.001
Neutrophils, %	67.3 ± 13.7	65.9 ± 13.5	67.2 ± 13.2	67.8 ± 13.8	68.3 ± 14.0	< 0.001
Platelet count, K/ul	247.0 (199.0, 303.0)	245.0 (198.0, 299.0)	247.0 (200.0, 302.0)	248.0 (200.0, 305.0)	249.0 (198.0, 304.0)	0.005
Potassium, mEq/l	4.2 ± 0.6	4.2 ± 0.6	4.2 ± 0.6	4.2 ± 0.6	4.3 ± 0.7	< 0.001
Red blood cells, m/ul	4.4 ± 0.6	4.3 ± 0.6	4.4 ± 0.6	4.4 ± 0.6	4.4 ± 0.7	< 0.001
Serum creatinine, mg/dl	0.9 (0.8, 1.1)	0.9 (0.7, 1.0)	0.9 (0.8, 1.1)	0.9 (0.8, 1.1)	1.0 (0.8, 1.2)	< 0.001
Sodium, mEq/l	139.2 ± 3.6	139.3 ± 3.5	139.5 ± 3.4	139.4 ± 3.4	138.6 ± 3.9	< 0.001
Urea nitrogen	16.0 (12.0, 22.0)	15.0 (11.0, 20.0)	16.0 (12.0, 21.0)	17.0 (13.0, 22.0)	17.0 (13.0, 24.0)	< 0.001
White blood cells	7.6 (6.0, 9.8)	6.9 (5.5, 8.8)	7.4 (5.9, 9.5)	7.9 (6.2, 10.1)	8.3 (6.5, 10.8)	< 0.001
TyG index	10.4 ± 0.7	9.6 ± 0.3	10.1 ± 0.1	10.6 ± 0.1	11.4 ± 0.6	< 0.001
Comorbidities, n (%)
Acute myocardial infarction	1101 (2.0)	168 (1.2)	236 (1.7)	291 (2.1)	406 (3)	< 0.001
Atrial fibrillation	4618 (8.5)	1118 (8.2)	1239 (9.1)	1224 (9)	1037 (7.6)	< 0.001
Cerebral infarction	3,797 (7.0)	808 (6)	959 (7.1)	1,015 (7.5)	1015 (7.5)	< 0.001
Chronic kidney disease	4250 (7.8)	675 (5)	944 (7)	1130 (8.3)	1501 (11.1)	< 0.001
Diabetes						< 0.001
NO	48,982 (90.3)	13,036 (96.2)	12,772 (94.2)	12,280 (90.5)	10,894 (80.3)
I	330 (0.6)	60 (0.4)	38 (0.3)	65 (0.5)	167 (1.2)
II	4815 (8.9)	443 (3.3)	733 (5.4)	1,204 (8.9)	2,435 (17.9)
Undetermined	136 (0.3)	16 (0.1)	22 (0.2)	27 (0.2)	71 (0.5)
Heart failure	8706 (16.0)	1729 (12.8)	2028 (15)	2260 (16.6)	2689 (19.8)	< 0.001
Hyperlipidemia	7429 (13.7)	1284 (9.5)	1875 (13.8)	2068 (15.2)	2202 (16.2)	< 0.001
Hypertension	20,302 (37.4)	4181 (30.8)	5070 (37.4)	5496 (40.5)	5555 (40.9)	< 0.001
Respiratory failure	6060 (11.2)	1074 (7.9)	1379 (10.2)	1558 (11.5)	2049 (15.1)	< 0.001
Events, n (%)
Acute kidney failure	13,624 (25.1)	2510 (18.5)	3059 (22.6)	3550 (26.1)	4505 (33.2)	< 0.001

Abbreviations: TyG: triglyceride glucose index; OR: odds ratio; CI: confidence interval.

^a TyG index quartiles: Q1 (5.344–9.911), Q2 (9.911–10.328), Q3 (10.328–10.81), Q4 (10.81–16.337).

Table 2. Univariate logistic regression analysis of incidence rate of acute renal failure.

Categories	OR(95CI)	p value
Male	1.52 (1.46–1.58)	< 0.001
Age	1.03 (1.03–1.03)	< 0.001
Black	2 (1.79–2.24)	< 0.001
Latino	1.2 (1.05–1.36)	0.008
White	1.78 (1.6–1.97)	< 0.001
Glucose	1.08 (1.08–1.09)	< 0.001
Triglycerides	1.01 (1.01–1.01)	< 0.001
Hemoglobin	0.82 (0.81–0.83)	< 0.001
Lymphocytes	0.98 (0.97–0.98)	< 0.001
Neutrophils	1.01 (1.01–1.02)	< 0.001
Platelet count	1 (1–1)	< 0.001
Potassium	1.41 (1.37–1.45)	< 0.001
Red blood cells	0.53 (0.51–0.54)	< 0.001
Serum creatinine	1.89 (1.83–1.95)	< 0.001
Sodium	0.97 (0.96–0.97)	< 0.001
Urea nitrogen	1.07 (1.06–1.07)	< 0.001
White blood cells	1.01 (1.01–1.01)	< 0.001
TyG	1.51 (1.47–1.55)	< 0.001
Acute myocardial infarction	1.79 (1.58–2.02)	< 0.001
Atrial fibrillation	2.56 (2.41–2.73)	< 0.001
Cerebral infarction	1.01 (0.94–1.09)	0.736
Chronic kidney disease	10.68 (9.94–11.47)	< 0.001
Diabetes I	4.46 (3.58–5.55)	< 0.001
Diabetes II	2.67 (2.51–2.84)	< 0.001
Undetermined	5.61 (3.96–7.94)	< 0.001
Heart failure	6.13 (5.84–6.44)	< 0.001
Hyperlipidemia	1.23 (1.16–1.29)	< 0.001
Hypertension	1.24 (1.19–1.29)	< 0.001
Respiratory failure	4.18 (3.96–4.42)	< 0.001

Abbreviation: TyG index: triglyceride glucose index; OR: odds ratio; CI: confidence interval.

Table 3. Multivariate logistic regression analyses of TyG index and incidence of acute kidney failure.

Categories	Model 1		Model 2		Model 3		Model 4
	OR(95%CI)	p value	OR(95%CI)	p value	OR(95%CI)	p value	OR(95%CI)	p value
TyG	1.51 (1.47–1.55)	<0.001	1.53 (1.49–1.57)	<0.001	1.41 (1.34–1.48)	<0.001	1.28 (1.22–1.35)	<0.001
Quartile
Q1(n = 13,555)	1(Ref)		1(Ref)		1(Ref)		1(Ref)
Q2(n = 13,565)	1.28 (1.21–1.36)	0.462	1.17 (1.1–1.24)	0.444	1.17 (1.1–1.25)	0.427	1.14 (1.06–1.22)	0.667
Q3(n = 13,576)	1.56 (1.47–1.65)	0.202	1.42 (1.34–1.51)	0.036	1.33 (1.25–1.42)	0.074	1.25 (1.17–1.34)	0.071
Q4(n = 13,567)	2.19 (2.07–2.31)	<0.001	2.12 (2–2.25)	<0.001	1.63 (1.52–1.76)	<0.001	1.43 (1.32–1.54)	<0.001
P for trend		<0.001		<0.001		<0.001		<0.001

Abbreviations: Q: quartile; TyG: triglyceride glucose index; OR: odds ratio; CI: confidence interval; Ref: reference.

Model 1: Not adjusted.

Model 2: Adjusted for age, sex, and race.

Model 3: Adjusted as for Model 2 plus glucose, triglycerides, hemoglobin, lymphocytes, neutrophils, platelet count, potassium, red blood cells, serum creatinine, sodium, urea nitrogen, white blood cells.

Model 4: Adjusted as for Model 3 plus acute myocardial infarction, atrial fibrillation, cerebral infarction, chronic kidney disease, diabetes, heart failure, hyperlipidemia, hypertension, and respiratory failure.

Table 4. Effect size of TyG index on the incidence of acute kidney failure in each subgroup.

Categories	No. of participants	n/N (%)	OR(95%CI)	p value	p for interaction
Age					0.998
Age < 65	32,116.0	6172 (19.2)	1.25 (1.17–1.33)	< 0.001
Age ≥65	22,147.0	7452 (33.6)	1.13 (1–1.26)	0.043
Atrial fibrillation					0.507
NO	49,645.0	11,598 (23.4)	1.28 (1.22–1.35)	< 0.001
YES	4618.0	2026 (43.9)	1.22 (0.94–1.57)	0.133
Respiratory failure
NO	48203.0	10,385 (21.5)	1.3 (1.23–1.38)	< 0.001	< 0.001
YES	6060.0	3239 (53.4)	1.16 (1.03–1.3)	0.011

Abbreviations: OR: odds ratio; CI: confidence interval.

Adjust for age, sex, race, glucose, triglycerides, hemoglobin, lymphocytes, neutrophils, platelet count, potassium, red blood cells, serum creatinine, sodium, urea nitrogen, white blood cells, acute myocardial infarction, atrial fibrillation, cerebral infarction, chronic kidney disease, diabetes, heart failure, hyperlipidemia, hypertension, and respiratory failure.

Figure 2. Linear dose-response relationship between triglyceride-glucose index and incidence of acute kidney failure. Adjustment factors included sex, age, race, glucose, triglycerides, hemoglobin, lymphocytes, neutrophils, platelet count, potassium, red blood cells, serum creatinine, sodium, urea nitrogen, white blood cells, acute myocardial infarction, atrial fibrillation, cerebral infarction, chronic kidney disease, diabetes, heart failure, hyperlipidemia, hypertension, and respiratory failure. The black line and pink line represent the estimated values and their corresponding 95% confidence intervals, respectively.

Figure 3. Subgroup analysis of the TyG index and acute renal failure.

Data availability statement

The dataset generated and analyzed in this study can be obtained from the authors upon reasonable request.