Xin Wang,1,* Xuerong Cui,2,* Huaping Fan,3 Tianyang Hu4 

1Department of Respiratory and Critical Care Medicine, Deyang People’s Hospital, Deyang, Sichuan, 618099, People’s Republic of China; 2Department of Respiratory Medicine, People’s Hospital of Shizhu Tujia Autonomous County, Chongqing, 409199, People’s Republic of China; 3Department of Cardiology, 63650 Military Hospital, Urumqi, Xinjiang, 841700, People’s Republic of China; 4Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Huaping Fan, Email doctfhp@163.com; Tianyang Hu, Email hutianyang@stu.cqmu.edu.cn

Purpose: The triglyceride-glucose (TyG) index is a surrogate biomarker of insulin resistance which has been widely used in intensive care unit (ICU) to predict prognosis. However, its role in critically ill acute exacerbation of COPD (AECOPD) patients remains largely unknown.
Material and methods: A total of 645 AECOPD patients were induced in this retrospective cohort study, which extracted data from the eICU Collaborative Research Database (eICU-CRD). The TyG index was calculated as Ln (fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2). The primary endpoint includes in-hospital mortality and ICU mortality. The secondary endpoint was sepsis, acute kidney injury (AKI), and acute respiratory failure (ARF).
Results: Multivariable Cox regression analysis revealed that the TyG index was independently associated with an increased risk of in-hospital mortality (hazard ratio, HR: 1.45, 95% CI: 1.04– 2.01, P = 0.028) and ICU mortality (HR: 2.13, 95% CI: 1.28– 3.54, P = 0.004). Moreover, the TyG index was independently associated with an increased risk of sepsis (odds ratio, OR: 1.54, 95% CI: 1.24– 1.93, P < 0.001), AKI (OR: 1.57, 95% CI: 1.26– 2.02, P < 0.001) and ARF (OR: 1.50, 95% CI: 1.20– 1.87, P < 0.001). Kaplan–Meier survival analysis revealed that higher TyG indexes were also related to increased in-hospital mortality and ICU mortality. In addition, the restricted cubic splines regression model demonstrated that the in-hospital mortality and ICU mortality increased linearly with increasing TyG index (P for non-linearity =  0.897, P for non-linearity =  0.897, respectively).
Conclusion: Elevated TyG index was independently associated with an increased risk of poor clinical outcomes in critically ill AECOPD patients. A prospective study to define TyG as a biomarker for prognosis prediction in critically ill AECOPD patients is warranted.

Keywords: triglyceride-glucose index, AECOPD, mortality, eICU-CRD database