Triglyceride-glucose index is associated with early neurological deterioration in single subcortical infarction: Early prognosis in single subcortical infarctions

Abstract

Background The research about the influence of triglyceride-glucose index on early prognosis in stroke is lacking. Aims In this study, we evaluated the association between triglyceride-glucose index and early neurological deterioration in patients with single subcortical infarctions. Methods Consecutive patients with single subcortical infarctions within 72 h of symptom onset between 2011 and 2015. Early neurological deterioration was defined as an increase of ≥2 in the total NIHSS score or ≥1 in the motor NIHSS score. The triglyceride-glucose index was calculated using the log scale of fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2. Results A total of 305 patients with single subcortical infarctions were evaluated. In multivariable analysis, the triglyceride-glucose index (adjusted odds ratio [aOR] = 2.94, 95% confidence interval [CI] = 1.58–5.45) and age (aOR = 1.05, 95% CI = 1.01–1.09) were associated with early neurological deterioration. In subgroup analysis according to the type of single subcortical infarctions, only patients with proximal single subcortical infarctions showed a significant association between the triglyceride-glucose index and early neurological deterioration (aOR = 2.92, 95% CI = 1.35–6.29). On the other hand, there was no statistical significance in patients with distal single subcortical infarctions. Patients with untreated diabetes also showed the close association between the triglyceride-glucose index and early neurological deterioration (aOR = 3.94, 95% CI = 1.47–10.52). Conclusions The triglyceride-glucose index was associated with early neurological deterioration in single subcortical infarctions. This association differed depending on the location of lesion and the presence of untreated diabetes.

High triglyceride-glucose index is associated with early recurrent ischemic lesion in acute ischemic stroke

“…Although the TG/HDL ratio was not significantly associated with ERIL, it showed a close tendency. On the other hand, the TyG index may possibly be an indicator of the compound influence of glucose and TG 20 , since hyperglycemia and hypertriglyceridemia are known to worsen the acute prognosis of ischemic stroke 18 , 19 . Therefore, we propose a future prospective study to analyze the relationship of ERIL incidence and the changes in the TyG index during the initial 7 days.…”

“…Indeed, both the TyG index and TG/HDL ratio were elevated in the IC-LAA and EC-LAA groups (Table 4 ). Therefore, it is possible that the instability of the underlying atherosclerotic plaques led to (1) artery-to-artery embolism, (2) stepwise progression from near occlusion to complete occlusion, and (3) hemodynamic failure, resulting in the occurrence of ERIL 20 , 27 . Consistent with the findings of previous studies, patients with stroke by CE or cryptogenic mechanism had a low frequency of ERIL 23 .…”

“…From this registry, we included AIS patients who underwent follow-up magnetic resonance imaging (MRI) within 7 days of admission between January 2010 and December 2016 29 . Then, the patients with the following conditions were excluded: (1) delay of > 7 days from symptom recognition to admission, (2) received diagnostic or therapeutic neuro-intervention procedures, or (3) previous use of glucose- or lipid-lowering agents before measurements 5 , 20 . Similar to the previous studies focusing on ERIL, we also excluded patients with the following stroke mechanisms: (1) small vessel occlusion (due to the low incidence of ERILs); (2) other determined; and (3) more than two mechanisms 23 .…”

“…Laboratory examinations were performed after 12 h of overnight fasting, including glucose profiles, lipid profiles, white blood cell (WBC) counts, and high-sensitivity C-reactive protein 20 . The TyG index was calculated using the formula of “the log scale of [fasting TG (mg/dL) x fasting glucose (mg/dL)/2] 15 , 22 .…”

“…Indeed, the TyG index has recently been found to be closely related to various metabolic, cardiovascular, and cerebrovascular diseases 12 – 17 . Fasting glucose and TG are well-known risk factors for stroke recurrence 18 , 19 , and a recent study has reported that the TyG index, also as a comprehensive indicator of acute hyperglycemia and hypertriglyceridemia, is associated with early neurological deterioration (END) in AIS patients 20 .…”