Predictive Value of Triglyceride-Glucose Index for In-hospital Mortality in Patients With Severe Fever With Thrombocytopenia Syndrome: A Multi-Center Observational Study

Abstract

Background: Triglyceride-glucose (TyG) index has been proposed as a reliable indicator for insulin resistance and proved to be closely associated with the severity and mortality risk of infectious diseases. It remains indistinct whether TyG index performs an important role in predicting in-hospital mortality in patients with severe fever with thrombocytopenia syndrome (SFTS).Methods: The current study retrospectively recruited patients who were admitted for SFTS from January to December 2019 at five medical centers. TyG index was calculated in accordance with the description of previous study: Ln [fasting triglyceride (TG) (mg/dl) × fasting blood glucose (FBG) (mg/dl)/2]. The observational endpoint of the present study was defined as the in-hospital death.Results: In total, 79 patients (64.9 ± 10.5 years, 39.2% female) who met the enrollment criteria were enrolled in the current study. During the hospitalization period, 17 (21.5%) patients died in the hospital. TyG index remained a significant and independent predictor for in-hospital death despite being fully adjusted for confounders, either being taken as a nominal [hazard ratio (HR) 5.923, 95% CI 1.208–29.036, P = 0.028] or continuous (HR 7.309, 95% CI 1.854–28.818, P = 0.004) variate. TyG index exhibited a moderate-to-high strength in predicting in-hospital death, with an area under the receiver operating characteristic curve (AUC) of 0.821 (95% CI 0.712–0.929, P < 0.001). The addition of TyG index displayed significant enhancement on the predictive value for in-hospital death beyond a baseline model, manifested as increased AUC (baseline model: 0.788, 95% CI 0.676–0.901 vs. + TyG index 0.866, 95% CI 0.783–0.950, P for comparison = 0.041), increased Harrell's C-index (baseline model: 0.762, 95% CI 0.645–0.880 vs. + TyG index 0.813, 95% CI 0.724–0.903, P for comparison = 0.035), significant continuous net reclassification improvement (NRI) (0.310, 95% CI 0.092–0.714, P = 0.013), and significant integrated discrimination improvement (0.111, 95% CI 0.008–0.254, P = 0.040).Conclusion: Triglyceride-glucose index, a novel indicator simply calculated from fasting TG and FBG, is strongly and independently associated with the risk of in-hospital death in patients with SFTS.

Impact of glycemia and insulin treatment in fatal outcome of severe fever with thrombocytopenia syndrome

“…In Zhang et al's study that investigated 77 patients with SFTS, elevated blood glucose levels were correlated with fatal outcomes compared with survival in patients with levels in the normal range . Another study indicated that the triglyceride-glucose (TyG) index, derived from triglyceride and fasting blood glucose levels, was associated with in-hospital death in patients with SFTS ( Zhang T. et al, 2021 ). However, most of the studies were either limited to patients with diabetes or biased by insufficient numbers of patients in comparison groups.…”

Association between the triglyceride glucose index and length of hospital stay in patients with heart failure and type 2 diabetes in the intensive care unit: a retrospective cohort study

“…The TyG index, serving as a novel surrogate marker for insulin resistance, has been extensively utilized in predicting the risk and severity of various diseases (31). Numerous clinical investigations on the association between the TyG index and patient outcomes across diverse diseases have been conducted.…”

Prognostic Value of Serum Ferritin for Patients with Severe Fever with Thrombocytopenia Syndrome: A Single-Center Retrospective Cohort Study

“…In 2017, the World Health Organization (WHO) listed SFTS as an infectious disease requiring urgent research and development because of its high case fatality rate and the possibility of transmission [8]. For seriously ill patients, the disease can quickly develop into multiple organ failure and eventually lead to adverse clinical outcomes [9]. Therefore, it is very important for SFTS patients to identify the high risk of adverse clinical outcome in time.…”