Association of triglyceride-glucose index with clinical outcomes in patients with acute ischemic stroke receiving intravenous thrombolysis

Abstract

Intravenous tissue plasminogen activator (tPA) remains the cornerstone of recanalization therapy for acute ischemic stroke (AIS), albeit with varying degrees of response. The triglyceride-glucose (TyG) index is a novel marker of insulin resistance, but association with outcomes among AIS patients who have received tPA has not been well elucidated. We studied 698 patients with AIS who received tPA from 2006 to 2018 in a comprehensive stroke centre. TyG index was calculated using the formula: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. TyG index was significantly lower in patients that survived at 90-days than those who died (8.61 [Interquartile Range: 8.27–8.99] vs 8.76 [interquartile range: 8.39–9.40], p = 0.007). In multivariate analysis, TyG index was significantly associated with 90-day mortality (OR: 2.12, 95% CI: 1.39–3.23, p = 0.001), poor functional outcome (OR: 1.41 95% CI: 1.05–1.90, p = 0.022), and negatively associated with early neurological improvement (ENI) (OR: 0.68, 95% CI: 0.52–0.89, p = 0.004). There was no association between TyG index and symptomatic intracranial hemorrhage. ‘High TyG’ (defined by TyG index ≥ 9.15) was associated with mortality, poor functional outcomes and no ENI. In conclusion, the TyG index, a measure of insulin resistance, was significantly associated with poorer clinical outcomes in AIS patients who received tPA.

Triglyceride-Glucose Index and the Prognosis of Patients with Acute Ischemic Stroke: A Meta-Analysis

“…Overall, 34 076 patients with acute IS from eight cohort studies 15 16 17 18 19 20 21 22 were included in the meta-analysis ( Table 1 ). Four prospective cohort studies 16 17 20 22 and four retrospective studies 15 18 19 21 were included, respectively, which were performed in China 15 16 17 19 20 22 , Korea 18 , and Singapore 21 . All the studies included hospitalized patients with acute IS, with mean ages varying from 62 to 72 years.…”

“…All the studies included hospitalized patients with acute IS, with mean ages varying from 62 to 72 years. TyG index was measured at admission, and the cutoffs for the analyses of TyG index varied among the included studies, with quartiles [15][16][17]22], tertiles [20], median [19], receiver operating characteristic (ROC) curve analysis derived value [21], and previous study evidenced cut-off for IR [18], respectively. The follow-up durations were within hospitalization for one study [15], three months for three studies [18,20,21], and 12 months for the other four studies [16,17,19,22].…”

“…TyG index was measured at admission, and the cutoffs for the analyses of TyG index varied among the included studies, with quartiles [15][16][17]22], tertiles [20], median [19], receiver operating characteristic (ROC) curve analysis derived value [21], and previous study evidenced cut-off for IR [18], respectively. The follow-up durations were within hospitalization for one study [15], three months for three studies [18,20,21], and 12 months for the other four studies [16,17,19,22]. Possible confounding factors such as age, sex, National Institutes of Health Stroke Scale (NIHSS) at admission, comorbidities, and concomitant medications were adjusted to a varying degree in the included studies when the association between TyG index and the risks of outcomes of interest were presented.…”

“…However, studies which evaluated the possible predictive role of TyG index for the prognosis of patients with acute IS showed inconsistent findings [15][16][17][18][19][20][21][22]. Some studies suggested that a higher TyG index may predict the mortality risk [15,21,22] or poor functional outcome [17][18][19][20][21] in patients with acute IS, but not all studies [16]. In this study, we performed a meta-analytic evaluation of the observational studies to comprehensively investigate the association between TyG index and clinical outcomes patients with acute IS, including risk of all-cause mortality and poor functional outcome.…”

“…Previous studies showed that a higher TyG index is independently associated with the risk of atherosclerotic CVDs, including stroke [13,14]. However, studies which evaluated the possible predictive role of TyG index for the prognosis of patients with acute IS showed inconsistent findings [15][16][17][18][19][20][21][22]. Some studies suggested that a higher TyG index may predict the mortality risk [15,21,22] or poor functional outcome [17][18][19][20][21] in patients with acute IS, but not all studies [16].…”