Relationship between triglyceride-glucose index and intravenous thrombolysis outcomes for acute ischemic stroke

Yıl 2025, Cilt: 8 Sayı: 1, 52 - 56, 12.01.2025

Selcen Duran , Aysu Yetiş

https://doi.org/10.32322/jhsm.1543216

Öz

Aims: The aim of this study was to investigate the effect of triglyceride glucose index, a marker of insulin resistance, on early neurological deterioration (END), development of intracerebral hemorrhage and hemorrhagic transformation and mortality in patients receiving intravenous thrombolytic therapy for acute ischemic stroke.
Methods: This retrospective study included 71 patients with acute ischemic stroke who received intravenous tissue plasminogen activator. Demographic data, clinical and radiological findings, fasting glucose and lipid profile, END, hemorrhage development and mortality rates were analyzed. We also calculated the triglyceride glucose (TyG) index and examined its correlation with early neurological deterioration, hemorrhage development and mortality.
Results: The median age was 74 years (41-88), with a female predominance of 54.9%. The incidence of intracerebral hemorrhage was 9.6%, while END occurred in 39.6% of cases, and the 30-day mortality rate was 28.2%. The mean TyG index was 7.8 (2.8-27.6). The receiver operating characteristic curve analysis indicated that the TyG index predicted mortality with an area under the curve of 84.4%, a sensitivity of 85%, and a specificity of 82.35% in patients with a TyG index above 10.01 (p<0.01). According to univariate analyse, the admission NIHSS score was associated with a 1.46-fold increase in the odds of mortality (odds ratio [OR]: 1.459), while a TyG index greater than 10.01 was associated with a 1763.9-fold increase in mortality risk (OR: 1763.9) (p=0.005; p=0.009, respectively). Patients with higher TyG index also exhibited significantly increased rates of mortality and END (p<0.001 for both). There was no association between development of hemorrhage and TyG index (p>0.05).
Conclusion: This study supports that a high TyG index is associated with END and mortality but not with the development of hemorrhage. Multicenter studies with larger sample size are needed.

Anahtar Kelimeler

Triglyceride glucose index, insulin resistance, intravenous thrombolytic therapy, acute ischemic stroke, hemorrhagic transformation

Destekleyen Kurum

none

Teşekkür

none

Akut iskemik inmede trigliserit-glikoz indeksi ile intravenöz trombolitik tedavi sonuçları arasındaki ilişki

Öz

Amaç: Bu çalışmanın amacı, akut iskemik inme nedeniyle intravenöz trombolitik tedavi alan hastalarda insülin direncinin bir belirteci olan trigliserit glukoz indeksinin erken nörolojik kötüleşme (ENK), intraserebral kanama ve hemorajik transformasyon gelişimi ve mortalite üzerine etkisini araştırmaktır.

Yöntem: Bu retrospektif çalışmaya akut iskemik inme nedeniyle intravenöz doku plazminojen aktivatörü (IV tPA) uygulanan 71 hasta dahil edildi. Demografik veriler, klinik ve radyolojik bulgular, açlık glukozu ve lipid profili, ENK, kanama gelişimi ve mortalite oranları analiz edildi. Trigliserid glukoz (TyG) indeksi hesaplanarak ve erken nörolojik bozulma, kanama gelişimi ve mortalite ile korelasyonu incelendi.

Sonuç: Yaş ortancası 74 (41-88) olup, %54.9'u kadındı. İntraserebral hemoraji insidansı %9.6 iken, olguların %39.6'sında ENK meydana geldi ve 30 günlük mortalite oranı %28.2 idi. Ortalama TyG indeksi 7.8 (2.8-27.6) idi. ROC eğrisi analizi, TyG indeksinin 10.01'in üzerinde olan hastalarda %84.4 eğri altında kalan alan, %85 duyarlılık ve %82.35 özgüllük ile mortaliteyi öngördüğünü göstermiştir (p<0.01). Tek değişkenli analize göre, başvuru NIHSS skoru mortalite olasılığında 1,46 kat artışla (odds oranı [OR]: 1,459) ilişkiliyken, 10,01'den büyük bir TyG indeksi mortalite riskinde 1763,9 kat artışla (OR: 1763,9) ilişkiliydi (sırasıyla p=0,005; p=0,009). TyG indeksi daha yüksek olan hastalarda da mortalite ve ENK oranlarında anlamlı artış görülmüştür (her ikisi için de p<0.001). Hemoraji gelişimi ile TyG indeksi arasında bir ilişki bulunmamıştır (p>0.05).

Sonuç: Bu çalışma, yüksek TyG indeksinin ENK ve mortalite ile ilişkili olduğunu ancak kanama gelişimi ile ilişkili olmadığını desteklemektedir. Daha geniş örneklemli çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Trigliserid glikoz indeksi, insülin direnci, intravenöz trombolitik tedavi, akut iskemik inme, hemorajik transformasyon

Kaynakça

• Larson ST, Ray BE, Wilbur J. Ischemic stroke management: posthospitalization and transition of care. Am Fam Physician. 2023;108(1):70-77.
• Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology. 2021;97(20_Supplement_2):S6-S16.
• Qiu L, Fu F, Zhang W, He J, Zhan Z, Cheng Z. Prevalence, risk factors, and clinical outcomes of remote intracerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke: a systematic review and meta-analysis. J Neurol. 2023; 270(2):651-661. doi:10.1007/s00415-022-11414-2
• Zhang B, Lei H, Ambler G, et al. Association between triglyceride-glucose index and early neurological outcomes after thrombolysis in patients with acute ischemic stroke. J Clin Med. 2023;12(10):3471. doi:10.3390/jcm12103471
• Liu H, Liu D, Zuo P. Association between insulin resistance markers and poor prognosis in patients with acute ischemic stroke after intravenous thrombolysis. Neurologist. 2024;29(4):218-224. doi:10.1097/nrl.0000000000000550
• Yang Y, Huang X, Wang Y, et al. The impact of triglyceride-glucose index on ischemic stroke: a systematic review and meta-analysis. Cardiovasc Diabetol. 2023;22(1):2-13. doi:10.1186/s12933-022-01732-0
• Hou Z, Pan Y, Yang Y, et al. An Analysis of the potential relationship of triglyceride glucose and body-mass index with stroke prognosis. Front Neurol. 2021;12:630140. doi:10.3389/fneur. 2021.630140
• Ding PF, Zhang HS, Wang J, et al. Insulin resistance in ischemic stroke: mechanisms and therapeutic approaches. Front Endocrinol (Lausanne). 2022;13:1092431. doi:10.3389/fendo.2022. 1092431
• Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299-304. doi:10.1089/met. 2008.0034
• Park HM, Lee HS, Lee YJ, Lee JH. The triglyceride-glucose index is a more powerful surrogate marker for predicting the prevalence and incidence of type 2 diabetes mellitus than the homeostatic model assessment of insulin resistance. Diabet Res Clin Pract. 2021;180:109042.
• Lin SF, Hu HH, Chao HL, et al. Triglyceride-glucose index and intravenous thrombolysis outcomes for acute ischemic stroke: a multicenter prospective-cohort study. Front Neurol. 2022;13: 737441. doi:10.3389/fneur.2022.737441
• Toh EMS, Lim AYL, Ming C, et al. Association of triglyceride-glucose index with clinical outcomes in patients with acute ischemic stroke receiving intravenous thrombolysis. Sci Rep. 2022;12(1):1596. doi:10.1038/s41598-022-05467-6
• Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST): an observational study. Lancet. 2007;369(9558):275-282. doi:10. 1016/s0140-6736(07)60149-4
• Wu Y, Yang Y, Zhang J, Liu S, Zhuang W. The change of triglyceride-glucose index may predict incidence of stroke in the general population over 45 years old. Cardiovasc Diabetol. 2023; 22(1):132. doi:10.1186/s12933-023-01870-z
• Calleja AI, García-Bermejo P, Cortijo E, et al. Insulin resistance is associated with a poor response to intravenous thrombolysis in acute ischemic stroke. Diabetes Care. 2011;34(11):2413-2417. doi:10.2337/dc11-1242
• Shimobayashi M, Albert V, Woelnerhanssen B, et al. Insulin resistance causes inflammation in adipose tissue. J Clin Invest. 2018;128(4):1538-1550. doi:10.1172/jci96139
• Jin R, Liu L, Zhang S, Nanda A, Li G. Role of inflammation and its mediators in acute ischemic stroke. J Cardiovasc Transl Res. 2013;6(5):834-851. doi:10.1007/s12265-013-9508-6
• Huang YW, Yin XS, Li ZP. Association of the systemic immune-inflammation index (SII) and clinical outcomes in patients with stroke: a systematic review and meta-analysis. Front Immunol. 2022;13:1090305. doi:10.3389/fimmu.2022.1090305
• Ma F, Li L, Xu L, et al. The relationship between systemic inflammation index, systemic immune-inflammatory index, and inflammatory prognostic index and 90-day outcomes in acute ischemic stroke patients treated with intravenous thrombolysis. J Neuroinflammation. 2023;20(1):220. doi:10.1186/s12974-023-02890-y
• Palomo I, Alarcón M, Moore-Carrasco R, Argilés JM. Hemostasis alterations in metabolic syndrome (review). Int J Mol Med. 2006; 18(5):969-974.
• Bas DF, Ozdemir AO, Colak E, Kebapci N. Higher insulin resistance level is associated with worse clinical response in acute ischemic stroke patients treated with intravenous thrombolysis. Transl Stroke Res. 2016;7(3):167-171. doi:10.1007/s12975-016-0453-y
• Rao NM, Levine SR, Gornbein JA, Saver JL. Defining clinically relevant cerebral hemorrhage after thrombolytic therapy for stroke: analysis of the National Institute of Neurological Disorders and Stroke tissue-type plasminogen activator trials. Stroke. 2014;45(9):2728-2733. doi:10.1161/strokeaha.114.005135