Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, August 26, 2024

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

 You do realize survivors want prevention of early neurological deterioration rather than this USELESS PREDICTION?  I'd have you all 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&#x;Mingzhu Deng1Kangping Song&#x;Kangping Song2Wei Xu&#x;Wei Xu2Guohua HeGuohua He2Jue HuJue Hu2Hui XiaoHui Xiao2Nina ZhouNina Zhou1Sufen ChenSufen Chen2Guilan XuGuilan Xu2Yangping TongYangping Tong2Dan ZhangDan Zhang2Zhen Wang
Zhen Wang2*Fangyi Li
Fangyi Li2*
  • 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 (1115). 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.

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