Abstract
Whether insulin resistance (IR) predicts worse functional outcome in ischemic stroke is still a matter of debate. The aim of the present study is to determine the association between IR and risk of poor outcome in 173 Chinese nondiabetic patients with acute ischemic stroke. This is a prospective, population-based cohort study. Insulin sensitivity, expressed by the homeostasis model assessment (HOMA) of insulin sensitivity (HOMA index = (fasting insulin × fasting glucose)/22.5). IR was defined by HOMA-IR index in the top quartile (Q4). Functional impairment was evaluated at discharge using the modified Rankin scale (mRS). The median (interquartile range) HOMA-IR was 2.14 (1.17–2.83), and Q4 was at least 2.83. There was a significantly positive correlation between HOMA-IR and National Institutes of Health Stroke Scale (r = 0.408; P<0.001). In multivariate analyses, patients in IR group were associated with a higher risk of poor functional outcome (odds ratio (OR) = 3.23; 95% confidence interval (CI) = 1.75–5.08; P=0.001). In multivariate models comparing the third and fourth quartiles against the first quartile of the HOMA-IR, levels of HOMA-IR were associated with poor outcome, and the adjusted risk of poor outcome increased by 207% (OR = 3.05 (95% CI 1.70–4.89), P=0.006) and 429% (5.29 (3.05–9.80), P<0.001). In a receiver operating characteristic curve (ROC) analysis of poor outcome, the area under the curve (AUC) increased from 0.80 to 0.84 (95% CI: 0.79–0.88) by adding HOMA-IR to clinical examination variables (P=0.02). High HOMA-IR index is associated with a poor functional outcome in nondiabetic patients with acute ischemic stroke.
Highlights
In China, the annual stroke mortality rate is approximately 1.6 million, which has become the leading cause of deaths and adult disability [1]
After adjusting for other established risk factors in univariate analysis, in multivariate models comparing the third and fourth quartiles against the first quartile of the homeostasis model assessment (HOMA)-Insulin resistance (IR), levels of HOMA-IR were associated with poor outcome, and the adjusted risk of poor outcome increased by 207% (OR = 3.05, P=0.006) and 429% (5.29 (3.05–9.80), P
Based on the receiver operating characteristic curve (ROC), the optimal cut-off value of HOMA-IR as an indicator for auxiliary diagnosis of poor outcomes was projected to be 2.53, which yielded a sensitivity of 73.7% and a specificity of 75.0%, with the area under the curve (AUC) at 0.79
Summary
In China, the annual stroke mortality rate is approximately 1.6 million, which has become the leading cause of deaths and adult disability [1]. And accurate prediction of outcome in stroke is important and influences risk-optimized therapeutic strategies. It is important to identify those stroke patients at high risk for poor outcome. IR is a pivotal pathophysiologic contributor to the increased risk of cardiovascular disease (CVD) [6,7,8,9].
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