Ouyang Qingrong, Zhang Chenqi, Zhang Hui, Xiong Taoying, Chen Yangmei, Zhang Peng
Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Department of Neurology and Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Cardiovasc Diabetol. 2025 Oct 28;24(1):409. doi: 10.1186/s12933-025-02956-6.
Insulin resistance (IR) is closely linked to the incidence and adverse outcomes of acute ischemic stroke (IS). However, the prognostic value of various surrogate IR indices remains inconsistent across studies. This study aimed to compare the associations and discriminative abilities of four surrogate IR indices-the triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), atherogenic index of plasma (AIP), and metabolic score for insulin resistance (METS-IR)-in relation to 28-day in-hospital mortality among critically ill patients with IS.
This study utilized data from the eICU database to investigate critically ill patients with IS. Associations between the four IR indices and short-term mortality were assessed using multivariate regression and Cox regression combined with restricted cubic spline modeling (RCS). Additionally, receiver operating characteristic (ROC) analysis was conducted to evaluate the discriminative performance of these surrogate IR indices. Stratified analyses were performed to identify potential interactions among demographic variables.
A total of 1346 critically ill patients with IS (52.60% female) were enrolled in the study. The overall 28-day mortality rate was 8.77%, with no significant differences between genders. Multivariate regression analysis indicated that both the TyG and the METS.IR were independently associated with increased mortality, with Hazard Ratios (HR) of 1.44 and 1.41, respectively. Dose-response analyses revealed linear associations of TyG and AIP with short-term mortality risk, whereas TyG-BMI and METS-IR exhibited nonlinear relationships with mortality risk that plateaued at higher values. ROC analysis demonstrated that the TyG index had relatively superior discriminative performance among the four IR surrogate indicators in the overall population, male patients, and those over 60 years of age. In contrast, AIP (AUC = 0.68) showed stronger discriminative ability in patients under 60 years compared to the other indices. Subgroup analyses further confirmed significant associations of TyG with mortality in males (HR = 1.49, 95% CI 1.17-1.90; p = 0.0013) and of AIP in patients under 60 years (HR = 1.58, 95% CI 1.07-2.32; p = 0.0204). No significant interactions were observed across sex or age subgroups for the four IR surrogate indices.
Four surrogate indices of IR were positively associated with short-term mortality risk in critically ill patients with IS. Among these indices, TyG and METS-IR demonstrated relatively stronger risk effects, while the AIP exhibited superior effect size and discriminative ability in patients under 60 years of age. In contrast, TyG-BMI displayed comparatively weaker performance both in the overall population and across subgroups. These findings address a critical gap in understanding the comparative utility of surrogate IR indices for assessing short-term mortality risk in severe IS. Routine evaluation of these indices may enhance clinical assessment and inform individualized patient management across different subgroups. Furthermore, incorporating robust indicators such as TyG into clinical risk assessment models could enhance the precision of mortality predictions and facilitate optimized patient management strategies.
胰岛素抵抗（IR）与急性缺血性卒中（IS）的发病率和不良结局密切相关。然而，不同替代IR指标的预后价值在各研究中仍不一致。本研究旨在比较四种替代IR指标——甘油三酯-葡萄糖指数（TyG）、TyG-体重指数（TyG-BMI）、血浆致动脉粥样硬化指数（AIP）和胰岛素抵抗代谢评分（METS-IR）——与IS重症患者28天院内死亡率的相关性及判别能力。
本研究利用eICU数据库的数据调查IS重症患者。使用多变量回归和Cox回归结合受限立方样条模型（RCS）评估四个IR指标与短期死亡率之间的关联。此外，进行受试者工作特征（ROC）分析以评估这些替代IR指标的判别性能。进行分层分析以确定人口统计学变量之间的潜在相互作用。
本研究共纳入1346例IS重症患者（52.60%为女性）。28天总体死亡率为8.77%，男女之间无显著差异。多变量回归分析表明，TyG和METS-IR均与死亡率增加独立相关，风险比（HR）分别为1.44和1.41。剂量反应分析显示，TyG和AIP与短期死亡风险呈线性关联，而TyG-BMI和METS-IR与死亡风险呈非线性关系，在较高值时趋于平稳。ROC分析表明，在总体人群、男性患者和60岁以上患者中，TyG指数在四个IR替代指标中具有相对较好的判别性能。相比之下，与其他指标相比，AIP（AUC = 0.68）在60岁以下患者中显示出更强的判别能力。亚组分析进一步证实，TyG与男性死亡率显著相关（HR = 1.49，95%CI 1.17 - 1.90；p = 0.0013），AIP与60岁以下患者死亡率显著相关（HR = 1.58，95%CI 1.07 - 2.32；p = 0.0204）。四个IR替代指标在性别或年龄亚组中均未观察到显著的相互作用。
IR的四个替代指标与IS重症患者的短期死亡风险呈正相关。在这些指标中，TyG和METS-IR显示出相对较强的风险效应，而AIP在60岁以下患者中显示出更好的效应量和判别能力。相比之下，TyG-BMI在总体人群和各亚组中的表现相对较弱。这些发现填补了在理解替代IR指标评估严重IS短期死亡风险的比较效用方面的关键空白。对这些指标进行常规评估可能会加强临床评估，并为不同亚组的个体化患者管理提供依据。此外，将诸如TyG等可靠指标纳入临床风险评估模型可以提高死亡率预测的准确性，并促进优化的患者管理策略。
