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Original article
Available online 23 September 2025
U-shaped association between triglyceride/HDL ratio and all-cause mortality in obese sepsis patients: A retrospective study based on eICU database
Asociación en forma de U entre la razón triglicéridos/HDL y la mortalidad por causas varias en pacientes obesos con sepsis: un estudio retrospectivo basado en la base de datos eICU
Yaozhou Wua,1, Yingying Sunb,1, Ruirui Wangd, Qianqian Liua, Wenjie Wanga, Rubing Guod, Wei Zhaoc, Lianhua Weia,
a Department of Clinical Laboratory, Gansu Provincial Hospital, Lanzhou 730000, P.R. China
b Department of Clinical Laboratory, Lanzhou Pulmonary Hospital, Lanzhou 730000, P.R. China
c Department of Clinical Laboratory, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China
d School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, P.R. China
Received 18 January 2025. Accepted 19 August 2025
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Table 1. Description of the study population.
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Table 2. Univariate analysis.
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Table 3. Analysis of multiple regression equations.
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Abstract
Objective

This study explored the link between the TG/HDL ratio and mortality in obese sepsis patients using the eICU database.

Design

Retrospective observational study.

Setting

Intensive Care Medicine.

Patients

According to Sepsis 3.0 criteria, sepsis is diagnosed with infection and a SOFA score ≥2. This study included adults (age ≥18) with ICU stays ≥48 h to ensure data stability. Patients with diabetes, acute pancreatitis, or those on lipid-lowering or antidiabetic treatments were excluded due to their impact on lipid and glucose metabolism, which could bias the analysis of the TG/HDL ratio and all-cause mortality.

Interventions

938 obese sepsis patients were selected, and statistical methods (variable assessment, difference test, regression model, curve fitting, subgroup analysis) were used. The study was carried out using R 4.3.2 software.

Main variables of interest

TG/HDL.

Results

The TG/HDL ratio varied across quartiles and was significantly linked to mortality in obese sepsis patients. Regression and curve fitting showed a U-shaped relationship for TG/HDL < 8, with an inflection point at 3.59. The K–M curve confirmed this U-shaped pattern, and subgroup analysis revealed a significant interaction with hypertension.

Conclusions

A U-shaped relationship exists between TG/HDL and mortality in obese sepsis patients, with both low and high levels increasing death risk.

Keywords:
TG/HDL
Obese sepsis
All-cause mortality
U-shaped curve
Prognostic assessment
Resumen
Objetivo

Este estudio exploró la relación entre la razón TG/HDL y la mortalidad en pacientes obesos con sepsis utilizando la base de datos eICU.

Diseño

Estudio observacional retrospectivo.

Ámbito

Medicina de Cuidados Intensivos.

Pacientes

Según Sepsis 3.0, la sepsis se diagnostica con infección y SOFA ≥ 2. Se incluyeron adultos en UCI ≥ 48 horas, excluyendo a pacientes con diabetes, pancreatitis aguda o tratamientos que afecten lípidos y glucosa para evitar sesgos.

Intervenciones

Se seleccionaron 938 pacientes obesos con sepsis, y se utilizaron métodos estadísticos (evaluación de variables, prueba de diferencias, modelo de regresión, ajuste de curvas, análisis de subgrupos). El estudio se realizó utilizando el software R 4.3.2.

Variables de interés principales

TG/HDL.

Resultados

La razón TG/HDL varió entre cuartiles y se asoció significativamente con la mortalidad en pacientes obesos con sepsis. El análisis mostró una relación en forma de U para TG/HDL < 8, con un punto de inflexión en 3.59. La curva K-M y el análisis de subgrupos confirmaron este patrón, destacando una interacción con la hipertensión.

Conclusiones

Existe una relación en forma de U entre el TG/HDL y la mortalidad en pacientes obesos con sepsis, siendo los niveles tanto bajos como altos los que aumentan el riesgo de muerte.

Palabras clave:
TG/HDL
Sepsis en obesos
Mortalidad por todas las causas
Curva en forma de U
Evaluación pronóstica

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