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

Emma M S Toh,Vijay Kumar Sharma,Jamie S Y Ho,Chua Ming,Bryce W Q Tan,Ching-Hui Sia,Amanda Y L Lim,Bernard P L Chan,Aloysius S T Leow,Leonard L L Yeo,Benjamin Y Q Tan

doi:10.1038/s41598-022-05467-6

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.

Highlights

Intravenous tissue plasminogen activator remains the cornerstone of recanalization therapy for acute ischemic stroke (AIS), albeit with varying degrees of response
While previous authors have found an association between incidence of AIS and TyG index[21,22], limited studies have reported the effect of the TyG index on post-stroke clinical outcomes or r ecurrence[23–25], and the relationship of the TyG index in a thrombolyzed patient cohort has been studied scarcely
The patient cohort had a median age of 65 years (IQR: 55–76), was predominantly male (n = 420, 61.5%) and of Chinese ethnicity (n = 424, 68.7%), and the median admitting National Institute of Health Stroke Scale (NIHSS) was 14 (IQR: 8–21)

Summary

Introduction

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. The TyG index, a measure of insulin resistance, was significantly associated with poorer clinical outcomes in AIS patients who received tPA. Patients risk having symptomatic intracranial hemorrhage (SICH) following IV tPA4 These highlight a need for greater risk stratification to guide clinical decision making in thrombolysis. A reliable and practical measure of metabolic disease should be utilized to re-assess this relationship with post-thrombolysis stroke outcomes. The TyG index performed superiorly to fasting glucose and triglycerides alone in predicting development of Type 2 d iabetes[17], and notably increased the risk of cardio-cerebrovascular d isease[18], suggesting the TyG index may potentially be a good marker of metabolic disease to predict post-stroke outcomes. We sought to understand the association of the TyG index, as a reflection of IR, in AIS patients who underwent thrombolysis

Methods

Results

Conclusion