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. 2025 Jul 30:12:1605843.
doi: 10.3389/fmed.2025.1605843. eCollection 2025.

Emergency risk stratification using the TyG index: a multi-center cohort study on nonlinear association with 28-day mortality among critically ill patients transferred from the ED to the ICU

Zhenhua Huang  1   2 , Jianshe Bu  3 , Ke Yu  4 , Wanjie Gu  5 , Haiyan Yin  5
Affiliations

Emergency risk stratification using the TyG index: a multi-center cohort study on nonlinear association with 28-day mortality among critically ill patients transferred from the ED to the ICU

Zhenhua Huang et al. Front Med (Lausanne). .

Abstract

Background: In the emergency department (ED), rapid risk stratification of critically ill patients is essential for timely intervention. The triglyceride-glucose (TyG) index, a simple marker of insulin resistance, may aid in early mortality prediction, but its utility in ED-to-ICU patients remains unexplored.

Methods: Using data from the eICU Collaborative Research Database, we conducted a retrospective multicenter cohort study of 11,593 ED-to-ICU critically ill patients. The TyG index was calculated at ED presentation. The primary outcome was 28-day all-cause mortality. Multivariable Cox regression, restricted cubic splines, and sensitivity analyses were performed to assess associations.

Results: Among patients (mean age 63.6 ± 15.7 years, 57.3% male), 28-day mortality was 6.96%. The relationship between the TyG index and mortality was nonlinear, featuring a critical threshold at a TyG index value of 9.84. Below this cutoff, each unit increase in TyG index significantly elevated mortality risk (HR 1.47, 95% CI 1.20-1.69, p < 0.0001), while above it, the risk plateaued (HR 1.04, 95% CI 1.03-1.05, p = 0.097). The association remained robust after adjustment for confounders (adjusted HR 1.19, 95% CI 1.04-1.35, p = 0.0089) and across sensitivity analyses.

Conclusion: The TyG index, readily obtainable at ED presentation, provides emergency clinicians with a practical tool for early mortality risk stratification in critically ill patients. Its nonlinear association with 28-day mortality suggests a saturation effect, enabling rapid identification of high-risk patients who may benefit from intensified monitoring and intervention.

Keywords: ICU admission; emergency critical care; insulin resistance; mortality prediction; risk stratification; triglyceride-glucose index.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study population. ICU, intensive care unit.
Figure 2
Figure 2
Distribution of TyG index. It presented a normal distribution, ranging from 6.54 to 11.39, with a mean of 8.96.
Figure 3
Figure 3
Kaplan–Meier curves for all-cause mortality. The probability of all-cause mortality increased progressively with a rising TyG index.
Figure 4
Figure 4
Associations between TyG index and all-cause mortality in critically ill patients. A threshold, nonlinear association between TyG index and all-cause mortality was identified using a generalized additive model (GAM). The solid red line represents the smooth curve fitted between the variables. The blue bands represent the 95% CI from the fitted model. The analysis was adjusted for gender, age, ethnicity, BMI, SOFA score, GCS score, APACHE IV, BUN, Scr, TC, HDL, COPD, CHF, AMI, and DM.
Figure 5
Figure 5
Effect size of TyG index on all-cause mortality in prespecified and exploratory subgroups. Above model adjusted for gender, age, ethnicity, BMI, SOFA score, GCS score, APACHE IV, BUN, Scr, TC, HDL, COPD, CHF, AMI, and DM. In each case, the model is not adjusted for the stratification variable when the stratification variable was a categorical variable.
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