Sun Wei, Shen Huixin, Wu Xiao, He Aini, Yao Xuefan, Chen Fei, Song Haiqing, Huang Xiaoqin
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
CNS Neurosci Ther. 2024 Dec;30(12):e70143. doi: 10.1111/cns.70143.
This study aimed to investigate the impact of the triglyceride-glucose index (TyG index) on clinical consequences in individuals with large vascular occlusion (LVO)-induced acute ischemic stroke (AIS) following endovascular treatment (EVT).
We conducted a single-center retrospective cohort study, including AIS with LVO who underwent EVT. Patients were categorized into TyG index groups, calculated as "(fasting triglyceride [mg/dL] × fasting blood glucose [mg/dL]/2)." Clinical outcomes were assessed, including poor outcome (modified Rankin Scale [mRS] > 2 [3-6]) at 90 days, early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH), and 90-day mortality after EVT. Logistic regression and restricted cubic splines (RCS) were used to examine the relationship between the TyG index and clinical outcomes. Receiver operating characteristic (ROC) curve was constructed to evaluate the prognostic capacity of the TyG index.
A total of 424 patients were included. Higher TyG levels were associated with worse functional outcome at 90 days (per unit: p = 0.006), sICH (per unit: p = 0.002, T3 versus T1: p = 0.004), and 90-day mortality (T2 versus T1: p = 0.011, T3 versus T1: p = 0.029) in logistic regression. A RCS model revealed a linear association between the TyG index and poor outcome at 90 days, sICH, and 90-day mortality (p for nonlinearity > 0.05). In ROC curve analysis, the traditional risk factors model (area under the curve [AUC]: 0.824, 95% CI: 0.784-0.859) was outperformed by the conventional risk factors + TyG index model (AUC: 0.845, 95% CI: 0.807-0.878) in predicting poor outcome (p = 0.021).
A higher TyG index is associated with worse clinical outcomes in LVO-induced AIS patients after EVT. Additionally, the TyG index enhances risk prediction of traditional risk factors for poor outcome.
本研究旨在探讨甘油三酯-葡萄糖指数（TyG指数）对大血管闭塞（LVO）所致急性缺血性卒中（AIS）患者血管内治疗（EVT）后临床结局的影响。
我们进行了一项单中心回顾性队列研究，纳入接受EVT治疗的LVO所致AIS患者。患者根据TyG指数分组，计算方法为“（空腹甘油三酯[mg/dL]×空腹血糖[mg/dL]/2）”。评估临床结局，包括90天时的不良结局（改良Rankin量表[mRS]＞2[3 - 6]）、早期神经功能恶化（END）、症状性颅内出血（sICH）以及EVT后的90天死亡率。采用逻辑回归和限制性立方样条（RCS）分析来研究TyG指数与临床结局之间的关系。构建受试者工作特征（ROC）曲线以评估TyG指数的预后能力。
共纳入424例患者。逻辑回归分析显示，较高的TyG水平与90天时较差的功能结局（每单位：p = 0.006）、sICH（每单位：p = 0.002，T3与T1比较：p = 0.004）以及90天死亡率（T2与T1比较：p = 0.011，T3与T1比较：p = 0.029）相关。RCS模型显示TyG指数与90天时的不良结局、sICH以及90天死亡率之间存在线性关联（非线性p＞0.05）。在ROC曲线分析中，传统危险因素模型（曲线下面积[AUC]：0.824，95%可信区间：0.784 - 0.859）在预测不良结局方面不如传统危险因素 + TyG指数模型（AUC：0.845，95%可信区间：0.807 - 0.878）（p = 0.021）。
较高的TyG指数与LVO所致AIS患者EVT后的不良临床结局相关。此外，TyG指数可增强对不良结局传统危险因素的风险预测。
