Triglyceride-glucose index: an independent risk factor for all-cause mortality in critically ill aneurysmal subarachnoid hemorrhage patients- a retrospective analysis of the MIMIC-IV database.

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe cerebrovascular event linked to high mortality and disability. The triglyceride-glucose index (TyG), a marker of insulin resistance, has not been thoroughly investigated for its impact on prognosis in ICU patients with aSAH. This study examines the association between TyG and all-cause mortality (ACM) in aSAH patients in the ICU. Data from the MIMIC-IV (version 3.0) database were used to identify severe aSAH patients via ICD-9/10 codes. Cox regression assessed the relationship between TyG and ACM, with restrictive cubic splines (RCS) and Kaplan-Meier curves for further analysis. Among 560 patients (55.2% female), the ACM rates were 18.1%, 23.3%, 24.1%, and 27.9% at overall, 30-day, 90-day, and 1-year follow-ups, respectively. Elevated TyG was independently associated with higher hospital ACM (aHR, 2.447; 95% CI, 1.416-4.228), 30-day (aHR, 2.998; 95% CI, 1.764-5.095), 90-day (aHR, 3.355; 95% CI, 1.983-5.676), and 1-year ACM (aHR, 4.298; 95% CI, 2.624-7.038). RCS showed a linear increase in risk as TyG exceeded 7.43. Subgroup analysis revealed stronger associations in those with cerebral parenchymal hemorrhage and pulmonary infections. TyG is an independent risk factor for ACM in critically ill aSAH patients. This study supports TyG as a prognostic tool for assessing mortality risk in these patients.