Insulin resistance estimated by estimated glucose disposal rate predicts outcomes in acute ischemic stroke patients

Zhengzhao Lu; Yunyun Xiong; Xueyan Feng; Kaixuan Yang; Hongqiu Gu; Xingquan Zhao; Xia Meng; Yongjun Wang

doi:10.1186/s12933-023-01925-1

Insulin resistance estimated by estimated glucose disposal rate predicts outcomes in acute ischemic stroke patients

Cardiovasc Diabetol. 2023 Aug 26;22(1):225. doi: 10.1186/s12933-023-01925-1.

Authors

Zhengzhao Lu^#^{1

2}, Yunyun Xiong^#^{1

2

3}, Xueyan Feng¹, Kaixuan Yang^{2

4}, Hongqiu Gu^{2

4}, Xingquan Zhao^{1

2}, Xia Meng², Yongjun Wang^{5

6

7

8}

Affiliations

¹ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing, China.
³ Chinese Institute for Brain Research, Beijing, China.
⁴ National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China.
⁵ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. yongjunwang@ncrcnd.org.cn.
⁶ China National Clinical Research Center for Neurological Diseases, Beijing, China. yongjunwang@ncrcnd.org.cn.
⁷ Chinese Institute for Brain Research, Beijing, China. yongjunwang@ncrcnd.org.cn.
⁸ Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, 2019RU018, Beijing, China. yongjunwang@ncrcnd.org.cn.

^# Contributed equally.

Abstract

Background: Estimated glucose disposal rate (eGDR), a simple and noninvasive measure of insulin resistance, has been proven to be an independent risk factor for first-time stroke and all-cause mortality. In this study, we aimed to investigate the associations between eGDR and the stroke outcome in patients with first-time acute ischemic stroke (AIS).

Methods: We included first-time AIS patients with available data on eGDR in the China National Stroke Registry III (CNSR-III), and divided the subjects into lower eGDR group (eGDR ≤ 6 mg/kg/min) and higher eGDR group (eGDR > 6 mg/kg/min). The primary outcome was excellent functional outcome (modified Rankin Scale score 0-1) at 3 months. Secondary outcomes included stroke recurrence and favorable functional outcome (modified Rankin Scale score 0-2) at 3 months, and functional outcome and combined vascular event at one year. Univariate and multivariate analyses were performed to evaluate the association between eGDR and outcomes.

Results: A total of 6,271 patients with AIS were included in this study. The median values of eGDR in lower and higher eGDR group were 5.0 mg/kg/min (interquartile range, 4.2-5.6) and 7.6 mg/kg/min (interquartile range, 6.8-9.6), respectively. Patients with higher eGDR were significantly associated with higher incidence of excellent functional outcome (adjusted odds ratio, 1.24; 95% confidence interval, 1.06-1.45; P < 0.01) at 3 months and favorable (adjusted odds ratio, 1.55; 95% confidence interval, 1.24-1.93; P < 0.01) and excellent (adjusted odds ratio, 1.28; 95% confidence interval, 1.08-1.51; P < 0.01) functional outcome at one year. However, there was no significant difference in stroke recurrence between these two groups at 3 months (adjusted odds ratio, 0.81; 95% confidence interval, 0.61-1.06; P = 0.12) and one year (adjusted odds ratio, 0.91; 95% confidence interval, 0.73-1.14; P = 0.41).

Conclusion: eGDR is a predictor of functional outcome in patients with AIS, independent of traditional cardiovascular predictors.

Keywords: Estimated glucose disposal rate; Insulin resistance; Ischemic stroke; Outcome; Secondary prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China / epidemiology
Glucose
Humans
Insulin Resistance*
Ischemic Stroke* / diagnosis
Ischemic Stroke* / therapy
Stroke* / diagnosis
Stroke* / therapy

Substances

Glucose