Association of higher triglyceride–glucose index and triglyceride-to-high-density lipoprotein cholesterol ratio with early neurological deterioration after thrombolysis in acute ischemic stroke patients

 Instead of uselessly predicting END; What the fuck is the solution to prevent it?  And your mentors and senior researchers were OK with this crapola research? Everyone here needs to be fired!

Association of higher triglyceride–glucose index and triglyceride-to-high-density lipoprotein cholesterol ratio with early neurological deterioration after thrombolysis in acute ischemic stroke patients

Mingzhu Deng^1†Kangping Song^2†Wei Xu^2†Guohua He²Jue Hu²Hui Xiao²Nina Zhou¹Sufen Chen²Guilan Xu²Yangping Tong²Dan Zhang²Zhen Wang^2*Fangyi Li^2*

• ¹Department of Neurology, Brain Hospital of Hunan Province, The Second People’s Hospital of Hunan Province, Changsha, China
• ²Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China

Background: Insulin resistance (IR) can predict the prognosis of patients suffering from cerebrovascular disorders. The triglyceride–glucose (TyG) index and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio have been confirmed to be easy and reliable indicators of IR. However, the relationships between the TyG index or TG/HDL-C ratio and early neurological deterioration (END) after thrombolysis in patients with acute ischemic stroke (AIS) are uncertain.

Methods: A retrospective analysis of 1,187 patients diagnosed with AIS who underwent intravenous thrombolysis between January 2018 and February 2024 was performed. Post-thrombolysis END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score of ≥4 within 24 h after thrombolysis. Logistic regression analysis was performed to explore the relationships of the TyG index and TG/HDL-C ratio with post-thrombolysis END. Receiver operating characteristic (ROC) analysis was used to assess the ability of the TyG index and TG/HDL-C ratio to discriminate post-thrombolysis END.

Results: Among the 1,187 recruited patients, 179 (15.08%) were diagnosed with post-thrombolysis END, and 1,008 (84.92%) were diagnosed with non-END. A binary logistic regression model indicated that the TyG index (odds ratio [OR], 2.015; 95% confidence interval [CI] 1.964–2.414, p = 0.015) and TG/HDL-C ratio (OR, 1.542; 95% CI, 1.160–2.049, p = 0.004) were independent factors for post-thrombolysis END. The area under the curve (AUC) values for the TyG index, TG/HDL-C ratio, and TyG index combined with the TG/HDL-C ratio for post-thrombolysis END were 0.704, 0.674, and 0.755, respectively.

Conclusion: This study indicates that the TyG index and TG/HDL-C ratio can be used as prognostic factors to predict post-thrombolysis END.

Introduction

Acute ischemic stroke (AIS), which is caused by sudden arterial blockage and results in neuronal damage, is the most common type of stroke (1, 2). The preferred treatment for AIS is intravenous recombinant tissue plasminogen activator in the early phase (≤4.5 h) (3, 4). Nevertheless, a minority of patients continue to experience early neurological deterioration (END) in which neurological impairments and symptoms intensify within 24 h after thrombolysis (5). END is associated with an increased risk of mortality and morbidity, and previous studies have shown that END is relevant to unfavorable long-term outcomes in AIS patients (6, 7). Therefore, it is important to investigate the risk factors and measurable indicators of post-thrombolysis END in AIS patients.

Insulin resistance (IR) is considered the primary pathophysiology of metabolic syndrome (8), which is involved in the pathogenesis of cerebrovascular diseases, mainly through endogenous fibrinolytic dysfunction, thrombosis, elevated platelet activation, and inflammation (9). The hyperinsulinemic–euglycemic clamp test is the gold standard for assessing IR. However, the high cost of this measurement limits its wide-scale clinical applicability (10). In recent years, the triglyceride–glucose (TyG) index and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio have been established as reliable, cost-effective, and easily accessible surrogate markers for IR (11–15). According to large cohort studies, the TyG index might be a useful IR biomarker for predicting the prognosis of stroke patients (16). A higher TyG index is associated with more severe END in AIS patients (11). Moreover, prior research has demonstrated that an elevated TyG index is associated with poor outcomes after thrombolysis (9, 17, 18). However, there are conflicting relationships between metabolic syndrome and outcomes after thrombolysis (19, 20). Therefore, the relationship between the TyG index and post-thrombolysis END deserves further investigation. The TG/HDL-C ratio is an easily accessible serum biomarker and may be utilized for assessing IR (13). Previous studies have shown significant associations between the TG/HDL-C ratio and incident cardiovascular disease (13, 21). Nevertheless, a recent large-scale cohort study revealed that there was no significant correlation between TG/HDL-C and worse cardiovascular disease outcomes (12). Furthermore, few studies have investigated the correlation between the TG/HDL-C ratio and post-thrombolysis END.

The early neurological outcome after thrombolysis is related to the long-term prognosis of patients (7, 22). The correlation between the TyG index or HDL-C ratio and post-thrombolysis END remains unclear. Therefore, we investigated the associations of the TyG index and TG/HDL-C ratio with the risk of post-thrombolysis END.

Results

Clinical and demographic characteristics of AIS patients with post-thrombolysis END and non-END

Table 1 shows the clinical and demographic characteristics of the patients in detail. The baseline characteristics of the AIS patients from the two hospitals are shown in Supplementary Table S1. In our study, post-thrombolysis END was observed in 179 patients (15.08%), and post-thrombolysis non-END was observed in 1008 patients (84.92%). In the post-thrombolysis END group, the NIHSS score after rt-PA for 24 h (p < 0.001), DBP (p = 0.026), diabetes mellitus (p = 0.014), FBG (p < 0.001), TG (P = <0.001), TC (p = 0.003), TyG index (p < 0.001), and TG/HDL-C ratio (p < 0.001) were significantly greater than those in the post-thrombolysis non-END group, whereas HDL-C (p = 0.012) was significantly lower than those in the post-thrombolysis non-END group. In the post-thrombolysis END group, the percentage of patients with symptomatic intracranial hemorrhage (sICH) was 26.82% (48/179). In addition, stroke subtype (p = 0.011) was significantly different between the two groups. Figure 2 shows the TyG index, TG/HDL-C ratio, FBG, TG, TC, and HDL-C for the two groups.

 

More at link.