Impact of the triglyceride-glucose index on prognosis following endovascular therapy for acute ischemic stroke: effect modification by collateral circulation

 Prognosis DOES NOTHING to get survivors recovered! 
You need EXACT PROTOCOLS for that! When will you provide them?

You described an association but did NOTHING to solve the underlying problem of 100% recovery!  Until we get survivors in charge stroke research will continue to be useless for survivors. 

Impact of the triglyceride-glucose index on prognosis following endovascular therapy for acute ischemic stroke: effect modification by collateral circulation

• 

  Yishu Wang

• Q

  Qinyu Lei

• J

  Jiaqi Wang

• Y

  Yachao Lin

• L

  Liguo Xu *

• Department of Interventional Radiology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China

Abstract

Objective: 

To investigate the association between the triglyceride-glucose (TyG) index and 90-day functional outcome after endovascular therapy in patients with acute ischemic stroke, to evaluate the risk assessment performance of the TyG index combined with clinical variables, and to assess the effect-modifying role of collateral circulation in this association.

Methods: 

A retrospective analysis was conducted in 209 patients with acute ischemic stroke who underwent endovascular therapy at our hospital between October 2022 and December 2025. Multivariable logistic regression was performed to evaluate factors associated with poor functional outcome, defined as a modified Rankin Scale (mRS) score > 2 at 90 days. Interaction and stratified analyses were conducted to assess whether collateral circulation modified the association between the TyG index and clinical outcomes. Receiver operating characteristic (ROC) curves and the corresponding area under the curve (AUC) were used to evaluate the predictive performance of the TyG index combined with clinical variables. Differences in AUCs were compared using DeLong’s test. Calibration was assessed using the Hosmer-Lemeshow test, Brier score, and calibration curve, and internal validation was performed with 1,000 bootstrap resamples.

Results: 

A total of 209 patients were included, with 145 (69.4%) in the good functional outcome group (modified Rankin Scale [mRS] score≤2) and 64 (30.6%) in the poor functional outcome group (mRS > 2). Univariate analysis showed that the TyG index was significantly higher in the poor functional outcome group, and that sex, baseline National Institutes of Health Stroke Scale (NIHSS) score and collateral circulation status also differed significantly between the two groups (all p < 0.05). Multivariable logistic regression analysis showed that the TyG index was independently associated with poor functional outcome at 90 days after endovascular therapy (OR = 1.972, p < 0.001). A significant interaction was observed between the TyG index and collateral circulation (p = 0.012), suggesting a possible effect-modifying role of collateral circulation, and stratified analysis showed that this association appeared to be more pronounced in patients with poor collateral circulation. The combined risk assessment model showed good discriminative ability for poor functional outcome at 90 days (AUC = 0.834, sensitivity = 0.828, specificity = 0.731, DeLong’s test: p < 0.001), and the addition of the TyG index further improved the discriminative ability and assessment performance of the model.

Conclusion: 

The TyG index is an independent risk factor for poor 90-day functional outcome after endovascular therapy in patients with acute ischemic stroke. Collateral circulation may modify this association. The TyG index also improves the risk assessment performance of the combined risk model.

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TyG index signals higher risk after EVT in large-core ischemic stroke

 What will it take to change the status quo and reduce the risk to nothing?

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!

TyG index signals higher risk after EVT in large-core ischemic stroke

This study aims to evaluate the association between the triglyceride-glucose (TyG) index and the prognosis of patients with large ischemic core stroke received or did not receive endovascular treatment (EVT). This subanalysis from a multicenter, prospective registry study focused on patients with large ischemic core stroke. TyG, calculated by ln(triglycerides [mg/dL] × glucose [mg/dL]/2), was evaluated as both a four quartiles variable (⩽8.36 vs 8.36-8.85 vs 8.85-9.40 vs ⩾9.40) and a continuous variable. The primary outcome was the mRS score at 90 days, and the safety outcome was the 90-day mortality. Study registered at Chictr.org.cn (ChiCTR2100051664). Among 588 patients (54.4% men, median age 70 years), a higher continuous TyG index was associated with worse 3-month functional outcomes and increased mortality (adjusted odds ratio, 0.63; 95% confidence interval 0.50-0.78, p < 0.001; adjusted odds ratio, 1.6; 95% confidence interval, 1.31-2.18, p < 0.001). This association remained significant when TyG was treated categorically. A significant interaction between TyG index and treatment modalities was observed (p = 0.02). When the TyG index exceeded 9.18, the risk of death significantly increased in the EVT group. The TyG index more strongly associated with prognosis in EVT patients. Benefit of EVT became nonsignificant when TyG index exceeded 9.18.

Correlating the triglyceride glucose index with short-term neurological and functional prognosis following intravenous thrombolysis in acute ischemic stroke patients

You described a correlation, but NOTHING HERE will help get survivors recovered! The whole fucking point of stroke research is to get survivors recovered, and this completely FAILED! You're fired!

 Correlating the triglyceride glucose index with short-term neurological and functional prognosis following intravenous thrombolysis in acute ischemic stroke patients

Defeng Hua¹Zhen Guo^2*

• ¹Department of Neurology, Weifang People’s Hospital, Weifang, China
• ²Department of Clinical Laboratory, Weifang People’s Hospital, Weifang, China

Objective: To assess the correlation between the triglyceride glucose (TyG) index and short-term neurological and functional outcomes in patients with acute ischemic stroke (AIS) post-intravenous thrombolysis (IVT).

Methods: This prospective observational study included AIS patients treated with IVT within 4.5 h from symptom onset. The TyG index was calculated using fasting triglyceride and glucose levels. Neurological improvement was evaluated by a reduction in National Institutes of Health Stroke Scale (NIHSS) scores, and functional outcome by modified Rankin Scale (mRS) at discharge. Statistical analysis included correlation and regression analyses.

Results: Among 150 AIS patients, the TyG index significantly correlated with both NIHSS (rho = 0.45, p < 0.01) and mRS (rho = 0.38, p < 0.01) scores at discharge. A higher TyG index was associated with neurological non-improvement (OR = 2.11, p = 0.002) and poor functional outcomes (OR = 1.89, p = 0.005) after adjustment for confounders.

Conclusion: The TyG index is significantly associated with short-term outcomes in AIS patients post-IVT, suggesting its potential as a prognostic marker for stroke severity and recovery. Future studies with larger cohorts are needed to confirm these findings.

Elevated TyG-BMI Linked to Higher Short-Term Mortality in Critically ill Ischemic Stroke Patients: Study Finds

 How long before your competent? hospital gets this installed as a testing protocol with EXACT PROTOCOLS to fix the problem?

Do you prefer your doctor and hospital incompetence NOT KNOWING? OR NOT DOING? 

Elevated TyG-BMI Linked to Higher Short-Term Mortality in Critically ill Ischemic Stroke Patients: Study Finds

The association between triglyceride-glucose index and its combination with post-stroke depression: NHANES 2005–2018

 Why are you ignoring the elephant in the room explaining post stroke depression? It's incredibly simple; NO 100% RECOVERY PROTOCOLS!

You create EXACT 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE!

There would be no need for this useless research and no survivor depression.

The association between triglyceride-glucose index and its combination with post-stroke depression: NHANES 2005–2018

• Fengjiao Liang,
• Xiaoqian Shan,
• Xiang Chen &
• Banghua Yang 

BMC Psychiatry volume 25, Article number: 243 (2025) Cite this article

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Abstract

Background

Growing evidence indicates a link between insulin resistance and post-stroke depression (PSD). This study employed the triglyceride glucose (TyG) index as a measure of insulin resistance to investigate its relationship with PSD.

Methods

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2005–2018). PSD was assessed using data from patient health questionnaires, while the TyG index was calculated based on fasting venous blood glucose and fasting triglyceride levels. The formula used for the TyG index is ln[triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Participants were categorized into four groups according to the TyG index quartiles. A weighted multivariable logistic regression model was applied to examine the relationship between the TyG index and PSD.

Results

A total of 1217 patients were included in the study, of which 232 were diagnosed with PSD. The TyG index was divided into quartiles (Q1-Q4) for analysis. After adjusting for potential confounders, we found a significant positive association between the highest quartile of the TyG index (Q4: ≥9.33) and PSD (OR = 2.51, 95% CI: 1.04–6.07, p = 0.041). This suggests that in the U.S. adult stroke population, individuals with higher TyG indices are more likely to experience depressive symptoms. Subgroup analysis further confirmed a stable and independent positive association between the TyG index and PSD (all trend p > 0.05).

Conclusion

In this large cross-sectional study, our results suggest that among US adults who have experienced a stroke, those with higher TyG index levels are more likely to exhibit depressive symptoms. This provides a novel approach for the clinical prevention of PSD. Patients with higher TyG indices in the stroke population may require closer psychological health monitoring and timely intervention. Additionally, since the TyG index is calculated using only fasting blood glucose and triglyceride levels, it can help identify high-risk PSD patients, particularly in regions with limited healthcare resources.

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Introduction

Post-stroke depression (PSD) is one of the most prevalent complications following a stroke, marked by high incidence, mortality, and disability rates. A meta-analysis by Hackett et al., which included 51 studies, revealed that the comorbidity rate of PSD is approximately 33% [1]. Jianglong Guo summarized several representative studies and found that the incidence of PSD ranges from 11 to 41% [2]. Overall, about one-third of stroke patients experience depression. In recent years, the number of PSD patients has been gradually increasing due to the sharp rise in the number of stroke patients [1,2,3]. The occurrence of PSD significantly impacts the daily life and rehabilitation of stroke patients, increasing the burden on their families. Researches indicate that the development of PSD is closely related to various factors, including social factors and individual characteristics [4, 5].

Insulin resistance (IR) refers to the reduced sensitivity of insulin target cells to insulin concentration. It is not only associated with the occurrence of various metabolic-related diseases but also closely linked to the development of cardiovascular and cerebrovascular diseases [6, 7]. A longitudinal analysis of the Netherlands Study of Depression and Anxiety (NESDA) cohort by researchers from Stanford University revealed that individuals with insulin resistance exhibited a two-fold increased risk of developing major depressive disorder (MDD) compared to their insulin-sensitive counterparts. Notably, even among participants without baseline depressive symptoms, those with insulin resistance demonstrated a substantially elevated MDD incidence during follow-up [8]. Fernandes BS and colleagues have proposed that insulin resistance may serve as a biomarker for acute depressive states, with their meta-analysis demonstrating significant associations between IR and depression severity scores [9]. Studies have shown that for each unit increase in the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the risk of PSD in stroke patients increases accordingly [10, 11]. This confirms the positive correlation between insulin resistance and the risk of PSD, suggesting that insulin resistance is an independent risk factor for PSD. The HOMA-IR is useful for the early prediction and assessment of PSD. However, the calculation of HOMA-IR requires fasting serum insulin, which is not a routine biochemical indicator and is thus limited in clinical application (it is not practical in clinical practice).

The triglyceride-glucose index (TyG index) is also an effective means of assessing insulin resistance [12]. Compared to the HOMA-IR, the TyG index offers distinct advantages in clinical applicability. Its calculation does not require fasting insulin measurements, relying solely on triglycerides and fasting glucose levels, thereby simplifying implementation and reducing costs in routine practice [13]. Furthermore, the TyG index exhibits high sensitivity and specificity for identifying insulin resistance, outperforming HOMA-IR in detecting individuals with reduced insulin sensitivity across diverse populations [14]. Critically, the TyG index demonstrates superior predictive performance for metabolic abnormalities compared to HOMA-IR, with consistent efficacy observed in key subgroups such as older adults and individuals with obesity [15]. To date, no studies have directly indicated a correlation between the TyG index and the risk of PSD. Therefore, our research team used a cross-sectional design based on data from the National Health and Nutrition Examination Survey (NHANES) to evaluate whether there is an association between the TyG index and the risk of PSD. The aim of this study is to provide a potential new method for clinically identifying PSD, which could be used for the early detection of high-risk groups, thereby guiding targeted interventions to mitigate the burden of PSD and improve patient outcomes.

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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^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.

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The impact of triglyceride-glucose index on ischemic stroke: a systematic review and meta-analysis

 If this is that useful then write it up as a protocol and get it distributed AND implemented in ALL stroke hospitals. Failure to do so is complete incompetence on the part of stroke leadership.

The impact of triglyceride-glucose index on ischemic stroke: a systematic review and meta-analysis

• Ying Yang,
• Xiangting Huang,
• Yuge Wang,
• Lin Leng,
• Jiapei Xu,
• Lei Feng,
• Shixie Jiang,
• Jiang Wang,
• Yanrong Yang,
• Gaofeng Pan,
• Bing Jiang,
• Yan Wang &
• Lan Chen 

Cardiovascular Diabetology volume 22, Article number: 2 (2023) Cite this article

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Abstract

Background

Strokes significantly impair quality of life and incur high economic and societal burdens. The triglyceride and glucose (TyG) index is a biochemical marker of insulin resistance (IR) and may have important value in the prediction of strokes, especially ischemic stroke (IS). Our study aims to investigate the relationship between TyG index and IS and ascertain whether TyG index is independently associated with IS adverse outcomes.

Methods

The Cochrane, Embase, Medline, Web of Science, PubMed, and other relevant English databases and related websites were systematically searched for articles on ‘‘TyG index’’ and "stroke" published from inception to April 4, 2022. We reviewed the available literature on the TyG index and its relation to predicting IS occurrence in the general population and adverse clinical outcomes. We calculated odds ratios (OR) of TyG index and its predictability of IS occurrence and adverse outcomes. Statistical analyses were performed using the Meta Package in STATA, version 12.0.

Results

A total of 18 studies and 592,635 patients were included in our analysis. The pooled effect values of all stroke types showed that higher TyG index was associated with increased the risk of IS in the general population (OR 1.37; 95% CI 1.22–1.54) in a total sample of 554,334 cases with a high level of heterogeneity (P = 0.000, I² = 74.10%). In addition, compared to IS patients with a lower TyG index, IS patients with a higher TyG index was associated with higher risk of stroke recurrence (OR: 1.50; 95% CI 1.19–1.89) and increased risk of mortality (OR 1.40 95% CI 1.14–1.71). No correlation was found in the effect value combinations of poor functional outcomes (OR 1.12; 95% CI 0.88–1.43) and neurological worsening (OR: 1.76; 95% CI 0.79–3.95) in a total sample of 38,301 cases with a high level of heterogeneity (P = 0.000; I² = 77.20%).

Conclusions

TyG index has potential value in optimizing risk stratification for IS in the general population. Furthermore, there is a significant association between high TyG index and many adverse outcomes of stroke, especially stroke recurrence and high mortality. Future studies should focus on multi-center and multi-regional designs in order to further explore the relationship between IS and TyG index.

Introduction

A stroke is an acute neurologic condition that occurs due to a disruption of cerebral perfusion, resulting in focal or global neurological impairment [1]. Strokes can be broadly classified into ischemic strokes (IS) and hemorrhagic strokes (HS). Approximately 84.4% of strokes are ischemic in origin [1]. Annually, over 13.7 million strokes occur globally and cause 5.5 million deaths per year as well, with a predilection for the elderly population, though increasing prevalence is being reported in younger adults [2, 3]. As stroke causes death, dementia, and disability worldwide, this common condition decreases quality of life and incurs high economic and societal burdens [4,5,6]. Despite the improvement of strategies and techniques towards the management of stroke patients in recent years, recurrence of strokes continue to account for nearly 30% of all strokes and this high rate likely represents unsuccessful secondary prevention [4, 7]. Researchers have recognized that identifying stroke-prone individuals and targeting them effectively remains an important part of stroke management; however, this is not an easy task [4]. Frans Kauwa demonstrated that predictors assessed with magnetic resonance imaging (MRI) including multiple ischemic changes and isolated cortical lesions may have potential, but computed tomography (CT) or ultrasound are not reasonable choices. Unfortunately, overuse of MRI to predict strokes was not found to be feasible, thus portraying the incomplete utility of neuroimaging in this endeavor [8]. There are several validated risk factors as a target for IS prevention, such as hypertension, diabetes mellitus, hyperlipidemia, hypercoagulable states, current smoking, atrial fibrillation (AF), and premature ventricular complexes (PVC). However, these risk factors fail to explain all cases of stroke and lack uniform applicability [4, 9].

The triglyceride-glucose (TyG) index, is a biochemical marker of insulin resistance (IR), and can be calculated as ln (fasting triglycerides (mg/dl)×fasting blood glucose (mg/dl)/2) [10, 11]. IR is known to be a key mediator of the pathogenesis of type 2 diabetes, and thus elevated stroke risk. Hyperinsulinemic-euglycemic clamp (HIEC) is considered the current gold standard to determine IR; however, HIEC is complicated and time-consuming with limited applicability for clinical practice on a large scale [11]. Therefore, the TyG index has been validated as a simple surrogate marker of IR and is cost-effective and reproducible [12]. After initial studies on its use in diabetes, many other publications now have been released which acknowledge its utility in other disorders. The TyG index has been associated with the severity of arterial stiffness, cardiovascular disease (CVD), and metabolic syndrome (MetS) (a cluster of metabolic abnormalities characterized by hypertension, dyslipidemia, obesity, and glucose dysregulation) [10, 12,13,14,15]. More interestingly, Jiao et al. also reported that a high TyG index was associated with a 1.64-fold risk of all-cause mortality and 1.36-fold risk of major adverse cardiac event in elderly acute coronary syndrome patients [10].

Stroke is one of the most significant causes of death and disability, with most of the burden in low-income and middle-income countries. Improving poststroke outcomes is an urgent issue worldwide. Several studies have investigated the association of TyG index with the risk of stroke, and its sub-types [16,17,18]. A prospective study of 54,098 participants demonstrated that patients with higher TyG index experienced a 1.30-fold increased risk of IS [19]. Huang et al. reported that long-term elevated TyG index in hypertensive patients was significantly associated with an increased risk of stroke, especially IS [20]. However, Zhao et al. demonstrated a high TyG index was not associated with nondiabetic patients with non-ST-elevation myocardial infarctions [21]. Additionally, the effect of TyG indices with studying prognosis among patients with IS also attracts great attention. A study of the 16,310 patients from the China National Stroke Registry II found that the TyG index was associated with 1.25-fold increased risk of all-cause mortality and 1.32-fold increased risk of stroke recurrence among patients with ischemic stroke [22]. This association was not found to be consistent in patients with stroke treated with intravenous thrombolysis [23].

Based on these seminal studies, there are strong implications and suggestions that the TyG index may be independently associated with stroke recurrence and clinical outcomes. Therefore, our present systematic review and meta-analysis aims to summarize and pool the current available data in order to analyze this relationship between the TyG index and IS.

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