Yanli Sun,1,2 Wei Deng,3 Li Luo,1 Mingwei Chen1 

1Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, People’s Republic of China; 2Department of General Practice, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang City, Hubei Province, People’s Republic of China; 3Department of Neurology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang City, Hubei Province, People’s Republic of China

Correspondence: Mingwei Chen; Li Luo, Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Hefei City, Anhui Province, People’s Republic of China, Tel +86-551-2923631, +86-551-2926292, Email chmw1@163.com; 89200398@qq.com

Introduction: This study aims to investigate the significance of insulin resistance (IR) markers in predicting 48-hour hemorrhagic transformation and 3-month poor prognosis in acute ischemic stroke (AIS) patients of intravenous thrombolysis (IVT), with or without type 2 diabetes mellitus (T2DM).
Methods: A total of 1352 patients with AIS treated with IVT between January 2019 and December 2023 were retrospectively reviewed. We analyzed the prognostic value of IR markers, including the triglyceride-glucose (TyG) index, triglyceride and body mass index (TYG-BMI), and the insulin resistance metabolic score (METS-IR), in AIS patients who received IVT with or without T2DM. The primary outcome was 48-hour hemorrhagic transformation and 3-month poor prognosis (modified Rankin Scale [mRS] ≥ 3).
Results: Among 1181 enrolled patients, 328 were diagnosed with T2DM, representing 27.8% of the cohort. T2DM group showed a higher proportion of poor prognosis (23% vs.11%, p < 0.001), but no significant difference in hemorrhagic transformation between the two groups. TyG index, TyG-BMI, and METS-IR all demonstrated predictive value for 3-month poor prognosis, with the TyG index showing the highest predictive accuracy [area under the curve (AUC): 0.848]. The optimal cutoff point for predicting poor prognosis was 7.409, with sensitivity of 0.762 and specificity of 0.855 (p < 0.001). However, all three indexes were limited in their ability to predict hemorrhagic transformation.
Conclusion: Elevated TyG index is an independent risk factor for 3-month poor prognosis in AIS patients of IVT with or without type T2DM, with the TyG index showing the highest predictive value. These findings provide a new understanding that IR can be used as a therapeutic target for AIS patients of IVT.

Keywords: TyG index, TYG-BMI, METS-IR, hemorrhagic transformation, poor prognosis