Correlation of triglyceride-glucose index with unfavorable outcomes following moderate-to-severe traumatic brain injury
Objective To investigate the correlation between triglyceride-glucose(TyG)index on admission and unfavorable outcomes of patients with moderate-to-severe traumatic brain injury(msTBI)at 6 months postinjury.Methods A retrospective cohort study was conducted to analyze the clinical data of 277 patients with msTBI admitted to Affiliated Jiangyin Hospital of Nantong University from January 2019 to December 2022,including 208 males and 69 females,aged 18-88 years[(57.0±1 5.1)years].Glasgow Coma Scale(GCS)scores on admission were 3-8 points in 168 patients and 9-12 points in 109.According to the Glasgow Outcome Scale-Extended(GOSE)assessment at 6 months after injury,there were 121 patients with unfavorable outcomes(GOSE≤4 points)and 156 with favorable outcomes(GOSE≥5 points).The following indicators of the patients were recorded,including gender,age,history of diabetes,cause of injury,admission GCS,GCS motor score(GCSM),pupillary light reflex,worst Marshall CT classification within the first 24 hours after admission,admission TyG index,Mean Amplitude of Glycemic Excursions(MAGE)within 24 hours after admission,GCSM decline≥2 points within 72 hours after admission,craniotomy or not after admission,and prognosis,etc.TyG index served as the exposure variable focused in this study,which was calculated with fasting triglycerides and fasting blood glucose within 24 hours after admission.The 6-month prognosis of the patients was designated as the outcome variable of the study.After the patients were divided into different groups according to the three quantiles of the TyG index and unfavorable or favorable outcomes,the univariate analysis was conducted on watch variables,and variables with statistically significant differences were included in directed acyclic graphs(DAGs)for further identification of confounding variables.Factors which were found with no statistical significance in the univariate analysis but might affect insulin resistance after injury according to the authors'previous researches were also included in the DAGs analysis.Three Logistic regression models were designed(Model 1 without correction,Model 2 with core variables of International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury(IMPACT)corrected,and Model 3 with confounding variables screened by DAGs corrected)to analyze whether the TyG index was an independent risk factor for the prognosis of msTBI patients.The optimal Logistic regression model was selected and then restricted cubic spline(RCS)was employed to investigate the relationship between the TyG index and the unfavorable outcomes.Results The univariate analysis suggested that there were significant differences in gender,history of diabetes,MAGE,GCSM decline,and prognosis among the three quantiles of the TyG index(P＜0.05 or 0.01).Significant differences in age,history of diabetes,GCSM,pupillary light reflex,Marshall CT classification,TyG index,MAGE and GCSM decline were observed between unfavorable and favorable outcome groups(P＜0.05 or 0.01).The results of Logistic regression analysis that identified the confounding variables that influenced the correlation between the TyG index and unfavorable prognosis with DAGs suggested that a high TyG index level was significantly correlated with unfavorable outcomes in msTBI patients.Moreover,Model 3 that was corrected with confounding variables screened by DAGs had an optimal goodness-of-fit and adaptability.Model 3-based further RCS analysis indicated that the risk of unfavorable outcomes following msTBI may increase approximately linearly with the increase in TyG index within a certain range(TyG index＜9.79).Conclusions A high TyG index level on admission is the identified as an independent risk factor for unfavorable outcomes of patients with msTBI at 6 months postinjury.As the TyG index level increases,the risk of unfavorable outcomes also rises and may show a linear increasing trend within a certain range(TyG index＜9.79).
Brain injuriesPrognosisInsulinTriglyceride-glucose index
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