Association between triglyceride glucose body mass index and 1 year all cause mortality in stage 4 CKM syndrome patients

Abstract

The triglyceride-glucose body mass index (TyG-BMI) is acknowledged as a dependable surrogate biomarker for the evaluation of insulin resistance (IR). Current research indicates a significant correlation between TyG-BMI and the risk of subsequent cardiovascular events in individuals diagnosed with cardiovascular-kidney-metabolic syndrome (CKM) at stages 0-3. Nevertheless, the prognostic significance of TyG-BMI in patients with CKM stage 4 has not been extensively investigated, and there is a paucity of evidence available on this topic. The study utilized patient data from the Medical Information Mart for Intensive Care (MIMIC-IV) database, categorizing the data into quartiles based on the TyG-BMI index. The primary outcomes of interest were all-cause mortality at 180 days and at one year. To assess the relationship between the TyG-BMI index and these outcomes in patients diagnosed with stage 4 CKM, a Cox proportional hazards model was employed. Additionally, a restricted cubic splines(RCS) model was applied to further investigate the associations between the TyG-BMI index and the specified outcomes. A total of 1,885 patients participated in the study, with 62.49% of the cohort being male. The all-cause mortality rates were recorded at 30.50% at 180 days and 35.12% at one year. Analysis using a multivariate Cox proportional hazards model revealed that an increase in the TyG-BMI index was significantly correlated with a reduction in the risk of all-cause mortality at both the 180-day and one-year marks. Specifically, for each standard deviation increase in the TyG-BMI index, the risk of all-cause mortality decreased by 17% within 180 days (HR = 0.83, 95% CI: 0.76-0.91) and by 21% within one year (HR = 0.79, 95% CI: 0.71-0.87). Furthermore, regression analysis utilizing RCS indicated a linear decrease in all-cause mortality rates associated with increasing TyG-BMI index values over both the 180-day and one-year periods (P for nonlinearity = 0.171 and P for nonlinearity = 0.141, respectively). In patients diagnosed with stage 4 CKM syndrome, a reduced TyG-BMI index was found to be significantly correlated with a heightened risk of all-cause mortality within both 180 days and one year. Consequently, the TyG-BMI index may be utilized as an effective instrument for risk stratification and prognostic assessment in this patient population.

Keywords: Cardiovascular-Kidney-Metabolic syndrome; Insulin resistance; Obesity paradox; The triglyceride-glucose body mass index.

Fig. 1

Flow diagram of the patient selection process.

Fig. 2

Kaplan-Meier analyses for different endpoints among the quartiles of the triglyceride-glucose to body mass index (TyG-BMI) index. (A) One-year all-cause mortality rate; (B) 180-day all-cause mortality rate.

Fig. 3

RCS analysis between the TyG-BMI index and the one-year all-cause mortality rate (A) as well as the 180-day all-cause mortality rate (B) in the population with stage 4 CKM syndrome. Adjusted according to age, gender, BMI, marital status, hypertension, AMI, HF, stroke, ARF, WBC, RBC, PLT, HGB, RDW, HCT, K⁺, CA²⁺, CL⁻, GLU, INR, TG, BUN, and CREA.