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TRUVACE RECORD VERSION
record: TRV-2026-0862
version: 1
kind: certified
reason: Certified into the record
timestamp: 2026-08-24T06:05:41.449142Z
status: published
lens: trace
sector: health
headline: Triglyceride-glucose frailty index, metabolic-frailty phenotypes, and mortality in critically ill patients with acute kidney injury: Derivation, interpretation, and external validation
dek: Background Prognosis remains heterogeneous among critically ill patients with acute kidney injury (AKI). We evaluated the triglyceride-glucose frailty index (TyG-FI), a composite of metabolic burden and laboratory-based frailty, for mortality risk characterization, phenotype identification, prediction, and external validation. Methods We included 2230 adults with KDIGO-defined AKI from MIMIC-IV. Associations between TyG-FI and ICU, in-hospital, 28-day, 90-day, and 365-day mortality were assessed using multivaria…
gain_title: In 2230 MIMIC-IV adults with AKI, higher TyG-FI was independently associated with ICU and 28-day mortality and enabled identification of lower-burden versus high frailty-organ dysfunction phenotypes that reproduced in 1831 eICU patients with high agreement.
problem_title: The TyG-FI showed limited incremental predictive advantage over FI-Lab alone and reduced discrimination on external validation, with AUROCs dropping to 0.694 and 0.667 in eICU compared to 0.764 and 0.769 internally.
trace_subject: TyG-FI-based mortality risk characterization and metabolic-frailty phenotyping in critically ill patients with acute kidney injury
gain_reading: In 2230 MIMIC-IV adults with AKI, higher TyG-FI was independently associated with ICU and 28-day mortality and enabled identification of lower-burden versus high frailty-organ dysfunction phenotypes that reproduced in 1831 eICU patients with high agreement.
gain_evidence: Higher TyG-FI was independently associated with ICU mortality (OR, 1.524; 95% CI, 1.377-1.686) and 28-day mortality (HR, 1.234; 95% CI, 1.146-1.330) | Independently derived eICU phenotypes had 28-day mortality rates of 11.0% and 25.5%, while transported phenotypes had rates of 10.7% and 26.2%, with 95.4% agreement.
problem_reading: The TyG-FI showed limited incremental predictive advantage over FI-Lab alone and reduced discrimination on external validation, with AUROCs dropping to 0.694 and 0.667 in eICU compared to 0.764 and 0.769 internally.
problem_evidence: its incremental predictive advantage over FI-Lab alone or additive formulations was limited. | In eICU, the corresponding AUROCs were 0.694 and 0.667.
quick_read: Researchers derived and tested the triglyceride-glucose frailty index in 2230 MIMIC-IV adults with KDIGO-defined AKI, examining associations with ICU, in-hospital, 28-day, 90-day and 365-day mortality, identifying two consensus phenotypes, and evaluating 12 prediction algorithms with SHAP and LIME interpretation and external validation in 1831 eICU patients.

The findings matter because ICU-AKI prognosis is heterogeneous and multidimensional risk tools could inform triage and family discussions, but the observed drop in AUROC on external validation and the limited gain over FI-Lab alone leave uncertainty about clinical utility and whether the composite adds value beyond existing frailty measures.
limitation: Incremental predictive value of TyG-FI over frailty alone was limited, and external validation showed lower discrimination than internal testing.
tag: Dual reading
key_points: Study included 2230 adults with KDIGO-defined AKI from MIMIC-IV and 1831 eICU patients for external validation. | Consensus clustering identified K=2 metabolic-frailty phenotypes with 28-day mortality rates of 14.4% and 31.5% in MIMIC-IV. | Twelve prediction algorithms were evaluated using a 7:3 development-test split, with SHAP and LIME for interpretation and double machine learning as exploratory robustness analysis.
rundown: The analysis used multivariable logistic and Cox regression, restricted cubic splines, subgroup and sensitivity analyses to test TyG-FI associations across ICU, in-hospital, 28-day, 90-day, and 365-day mortality endpoints.

Phenotype reproducibility was assessed by independent clustering in eICU and by transport of locked MIMIC-IV centroids, yielding 95.4% agreement between independently derived and transported phenotype assignments.

Double-machine-learning estimates remained positive across sensitivity analyses, supporting robustness of the association between TyG-FI and mortality.
sources:
- peer_reviewed | Experimental Gerontology | https://doi.org/10.1016/j.exger.2026.113291 | 2026-08-22
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