Triglyceride-Glucose Index in Sepsis

SUMMARY:

  • Sepsis induces extensive release of inflammatory factors and stresses producing various imbalances.

  • Insulin resistance diminishes peripheral tissue insulin sensitivity.

  • The Triglyceride-Glucose Index (TyGI) has been presented as a surrogate marker of insulin resistance.

  • TyGI has been associated with various diseases and is emerging as a possible indicator in sepsis.

REVIEW:

  • The overall relationship between blood glucose and glycemic variability remains unclear.
  • Infection and inflammation also cause dramatic changes in lipid and lipoprotein levels within sepsis patients.

  • High plasma triglyceride concentrations have been associated with higher mortality rates in sepsis patients.

      • Triglyceride Levels (max): Survivors = 148.0; Non-Survivors = 136.0 (p0.013)
  • TyGI Calculation: Natural Log (Initial Triglyceride x Initial Plasma Glucose)/2

  • TyGI correlated with: contrast induced nephropathy; risk of ischemic stroke; coronary artery disease.
  • Relationship of TyGI in sepsis is only now being elucidated.
  • TyGI is independently being associated with increased sepsis mortality.

  • Acute Kidney Injury in Sepsis

    • 45 – 70% of acute kidney injuries (AKI) are secondary to sepsis
    • Sepsis AKI is linked to: poorer prognosis; longer length of stay; cardiovascular events; mortality.
    • A review of 1,426 patients with sepsis indicates TyGI is correlated with sepsis associated AKI and prolonged LOS.

CONCLUSIONS:

  • Initial studies demonstrate TyGI has a significant association between increased values and mortality and incidence of sepsis AKI.

  • It remains unclear if the TyGI can be used for the prognosis  or provide insights contributing to the clinical management and monitoring of sepsis patients.

  • Additional investigation in this area is warranted.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.