ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1605843
This article is part of the Research TopicInfections in the Intensive Care Unit - Volume IIIView all 22 articles
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
Provisionally accepted
- 1Shenzhen Second People's Hospital, Shenzhen, China
- 2First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
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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.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: Triglyceride-glucose index, emergency critical care, risk stratification, Insulin Resistance, Mortality prediction, Icu admission
Received: 09 Apr 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Huang, Bu, Yu, Gu and Yin. 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: Zhenhua Huang, Shenzhen Second People's Hospital, Shenzhen, China
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