ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Pediatric Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1598262
This article is part of the Research TopicCardiovascular Risks in Cardiovascular-Kidney-Metabolic Syndrome: Mechanisms and TherapiesView all 3 articles
U-Shaped Association Between Triglyceride-Glucose Index and Acute Kidney Injury in Critically Ill Children with Cardiac Diseases
Provisionally accepted
- Dongguan Institute of Pediatrics, Dongguan Children’s Hospital Affiliated to Guangdong Medical University, Dongguan, China
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Background: The triglyceride–glucose (TyG) index, a surrogate of insulin resistance (IR), has been linked to acute kidney injury (AKI) in adults, but its relevance in critically ill children with cardiac disease is unclear. This study aimed to examine this relationship in this vulnerable population. Methods: This retrospective analysis drew on data from the Pediatric Intensive Care (PIC) database, comprising 2298 critically ill children treated in the Cardiac Intensive Care Unit (CICU) between 2010 and 2019. The primary outcome was the AKI incidence, whereas secondary outcome focused on the occurrence of severe AKI. Restricted cubic splines (RCS) assessed nonlinearity. Multivariate two-segment Cox regression analyses estimated hazard ratios (HRs) across TyG segments after adjustment for confounders. Subgroup analyses evaluated effect modification across clinical strata. Results: Among 2,298 CICU pediatric patients (48.7% male), 15.6% developed AKI. A U-shaped relationship between the TyG index and AKI was identified using RCS. Specifically, When the TyG index was below 8.602, an inverse relationship was observed with the primary outcome (HR 0.69, 95% CI 0.48–0.98). Conversely, values at or above 8.602 were positively associated with the AKI incidence (HR 1.63, 95% CI 1.15–2.31). Similarly, for the secondary outcome, the inflection was at TyG 8.757: <8.757, HR 0.53 (0.28–0.99); ≥8.757, HR 2.75 (1.18–6.42). Subgroup and sensitivity analyses reinforced the robustness of these findings. Conclusions: The TyG index showed a nonlinear, U-shaped association with AKI in critically ill children with cardiac disease, with inflection points around 8.602 (AKI) and 8.757 (severe AKI). These findings suggest that TyG may support bedside risk stratification in this population.
Keywords: TyG index, AKI incidence, Children, Critically ill, cardiac disease, Insulin Resistance, PIC database
Received: 22 Mar 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Du, Ma, Ye, Song, Chen, Xiong, Zheng, Li, Yu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jiaxing Du, Dongguan Institute of Pediatrics, Dongguan Children’s Hospital Affiliated to Guangdong Medical University, Dongguan, China
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