| Objective: To investigate the relationship between triglyceride to high-density lipoprotein ratio(TG/HDL-C)with all-cause mortality and cardiovascular mortality in the maintenance hemodialysis patients.Methods: Patients undergoing maintenance hemodialysis treatment at the General Hospital of Northern Theater Command from June 2015 to September 2016 were consecutively enrolled in this study and retrospectively followed up until September2021.The endpoint events were all-cause death and cardiovascular death.Receiver operating curve(ROC)was drawn and the optimal TG/HDL-C threshold was calculated by the maximum Youden’s index.The enrolled patients were divided into two groups based on the threshold.The Kaplan-Meier method was applied for survival analysis,and log-rank test was used to compare the differences.Variables with statistical significance in univariate COX regression analysis(P<0.05)and influencing outcome by referring to previous literature were included in multivariate analysis.Multivariate COX regression models were constructed to assess the association between TG/HDL-C with all-cause mortality and cardiovascular death.Results: A total of 582 patients were included,with a mean age of 53.3±13.41 years old and 62.7% male.The median follow-up time was 68 months.159 patients died,82(51.6%)were attributed to cardiovascular disease.The restricted cubic spline curve showed a nonlinear relationship between TG/HDL-C level and mortality.The ROC curve analysis showed an area under the curve(AUC)of 0.554(95%CI: 0.50-0.61;P=0.044).The optimal threshold of TG/HDL-C was determined to be 1.71 based on the maximum Youden’s index,and patients were divided into two groups according to the threshold.Compared with the TG/HDL-C<1.71 group,the TG/HDL-C≥1.71 group had higher rates of diabetes,use of lipid-lowering drugs,higher levels of BMI,cholesterol,triglycerides and low-density lipoprotein,and lower levels of high-density lipoprotein.Kaplan-Meier analysis showed that the survival of patients in TG/HDL-C≥1.71 group was significantly higher than that in TG/HDL-C<1.71 group.Univariate COX regression analysis showed that advanced age,diabetes,hypertension and coronary heart disease were risk factors for all-cause death,while elevated levels of hemoglobin,albumin,low-density lipoprotein and TG/HDL-C≥1.7 were protective factors for all-cause death.After adjusting for confounding factors in COX hazard proportional regression models,TG/HDL-C≥1.71 was an independent protective factor for all-cause mortality(Model 1: HR: 0.70;95%CI:0.51-0.97;P=0.031;Model 2: HR: 0.55;95%CI: 0.39-0.77;P=0.001;Model 3: HR: 0.66;95%CI: 0.46-0.94;P=0.020;Model 4: HR: 0.66;95%CI: 0.46-0.94;P=0.021).Univariate COX regression analysis showed that advanced age,diabetes and hypertension were risk factors for cardiovascular death,while elevated levels of albumin,cholesterol,low-density lipoprotein and TG/HDL-C≥1.71 were protective factors for cardiovascular death.Adjusting for confounding factors in COX proportional regression models,TG/HDL-C≥1.71 was associated with reduced cardiovascular death(Model 1:HR: 0.59;95%CI: 0.38-0.93;P=0.024;Model 2: HR: 0.42;95%CI: 0.26-0.68;P < 0.001;Model 3: HR: 0.55;95%CI: 0.33-0.91;P=0.019;Model 4: HR: 0.59;95%CI: 0.35-0.97;P=0.038).TG/HDL-C≥1.71 was a protective factor for all-cause death(HR: 0.44;95%CI:0.26-0.75;P=0.003)and cardiovascular death(HR: 0.40;95%CI: 0.18-0.87;P=0.020)in hemodialysis patients<60 years old,and had no significant effect on patients ≥60 years old.In the non-diabetic subgroup,TG/HDL-C≥1.71 was associated with reduced all-cause death(HR: 0.54;95%CI: 0.33-0.89;P=0.017)and cardiovascular death(HR:0.34;95%CI: 0.15-0.81;P=0.014).Conclusion: 1.TG/HDL-C≥1.71 is associated with lower all-cause mortality and cardiovascular mortality in maintenance hemodialysis patients.2.High TG/HDL-C is an independent protective factor for mortality in hemodialysis patients aged <60 years or without diabetes. |
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