Insulin resistance has been associated with adverse cardiovascular and metabolic outcomes, although its relationship with sepsis risk remains less clearly defined. A prospective cohort study published in Frontiers in Endocrinology evaluated whether the triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, was associated with sepsis incidence and sepsis-related mortality according to diabetes status.

The analysis included 428,207 participants from the UK Biobank without prior cardiovascular disease who underwent baseline TyG index assessment. Investigators examined associations between the TyG index and long-term sepsis outcomes using Cox proportional hazards models stratified by diabetes status.

Findings

• Over a median follow-up of 13.04 years, 12,410 sepsis events and 6,291 sepsis-related deaths were recorded.
• Among participants with diabetes, each 1-unit increase in TyG index was associated with an 18% higher risk of sepsis incidence (hazard ratio [HR] 1.18; 95% confidence interval [CI] 1.10-1.27).
• In the subgroup with diabetes, each 1-unit increase in TyG index was also associated with a 16% higher risk of sepsis-related mortality (HR 1.16; 95% CI 1.05-1.27).
• In participants without diabetes, no significant associations were observed between TyG index and either sepsis incidence (HR 1.02; 95% CI 0.98-1.06) or sepsis-related mortality (HR 0.99; 95% CI 0.94-1.05).
• The relationship between the TyG index and sepsis outcomes was linear in participants with diabetes, whereas a U-shaped association was observed in individuals without diabetes.

A higher TyG index was independently associated with increased sepsis incidence and sepsis-related mortality in participants with diabetes, while similar associations were not observed in individuals without diabetes. The findings suggest the TyG index may help refine sepsis risk stratification in diabetes populations.