Triglyceride‐glucose index is strongly associated with all‐cause mortality in elderly females with diabetic foot ulcers: A 9‐year follow‐up study

Abstract This study aims to explore the association between the triglyceride‐glucose (TyG) index and all‐cause mortality in patients with diabetic foot ulcers (DFUs) through an ambispective cohort study. A total of 555 inpatients with DFUs were qualified to participate in the trial study from 2013 to 2022. Throughout a median 63‐month period, all subjects were followed up every 6 months. According to the three quantiles of the TyG index, participants were divided into three groups: low‐level (≤8.75, n = 185), moderate‐level (8.76–9.33, n = 185) and high‐level (≥9.34, n = 185). The association between the TyG index and all‐cause mortality in patients with DFUs was then assessed. During the follow‐up period, out of 555 patients with DFUs, 116 died (20.9%). After adjusting for confounding factors, the TyG index was positively associated with all‐cause mortality in patients with DFUs (HR = 1.733; 95% CI = 1.341–2.241; p < 0.001). Compared with the low‐level TyG index, the moderate‐level TyG index (HR = 1.685; 95% CI = 1.011–2.810; p = 0.045) and the high‐level TyG index (HR = 2.769; 95% CI = 1.678–4.568; p < 0.001) were positively correlated with all‐cause mortality in patients with DFUs. Additionally, in subgroup analysis, both females (HR = 1.905; 95% CI = 1.250–2.904; p = 0.003), males (HR = 1.729; 95% CI = 1.240–2.409; p = 0.001), younger (<65 years old) (HR = 1.467; 95% CI = 1.008–2.135; p = 0.046) and elderly (≥ 65) (HR = 1.933; 95% CI = 1.339–2.791; p < 0.001) showed a positive correlation between TyG index and all‐cause mortality rate in patients with DFUs. Furthermore, in the high‐level TyG index group compared, males (HR = 2.699; 95% CI = 1.457–4.998) and participants aged <65 years (HR = 2.031; 95% CI = 0.972–4.242), with the TyG index level increase by 1.0, the risk for all‐cause mortality increased 3.277‐fold in females (HR = 4.277; 95% CI = 1.645–11.124) and 1.909‐fold in elderly aged ≥65 years (HR = 2.909; 95% CI = 1.486–5.695), respectively. Kaplan–Meier survival curve analysis showed that the higher the TyG index level, the higher risk of all‐cause mortality in patients with DFUs (log‐rank, all p < 0.001). Briefly, this study implies a strong positive correlation between the TyG index and all‐cause mortality in patients with DFUs, especially in older women. Therefore, special attention should be paid to elderly females with DFUs because they have a higher TyG index level and risk of all‐cause mortality than other populations in daily clinical practice.