Xiaoli Yang1, Chen Li2, Jing Li3, Duanlu Hou4, Yufan Luo5, Shufan Zhang6, Zhi Jin7, Liwei Shen8, Ping Zhong9, Danhong Wu10. 1. Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. Electronic address: xiaoliyangsls@sina.com. 2. Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; Department of Neurology, Shanghai Ninth People's Hospital(North Part), Shanghai Jiaotong University, Shanghai, China. Electronic address: iambtlc@sina.com. 3. Department of Emergency, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. Electronic address: 1191971664@qq.com. 4. Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. Electronic address: houduanlu@163.com. 5. Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. Electronic address: yufanluo0305@163.com. 6. Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. Electronic address: m18895695186@163.com. 7. Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. Electronic address: nalanchongxuan@163.com. 8. Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China. Electronic address: shenlw78@126.com. 9. Department of Neurology, Shanghai Traditional Chinese and Western Medicine Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China. Electronic address: zphgl@163.com. 10. Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; Department of Neurology, Shanghai Ninth People's Hospital(North Part), Shanghai Jiaotong University, Shanghai, China. Electronic address: danhongwu@fudan.edu.cn.
Abstract
OBJECTIVES: to investigate the relationship between insulin resistance (IR) and clinical outcomes in non-diabetic ischemic stroke patients treated with intravenous thrombolysis. METHODS: We recruited non-diabetic ischemic stroke patients treated with intravenous thrombolysis prospectively. IR was defined as homeostasis model assessment-estimated insulin resistance index ≥2.80. Initial stroke severity was assessed using the National Institutes of Health Stroke Scale scores, and infarct volume was measured using DWI. Clinical outcomes were evaluated by neurological improvement and hemorrhagic transformation at 24 hours, and favorable functional prognosis at 90 days. RESULTS: 232 patients were enrolled into this study. IR group was 67 patients, non-IR group was 165 patients. Compared with the non-IR group, the probability of neurological improvement at 24 h ours and favorable functional outcome at 90 days in IR group were all significantly lower (41.79% vs 63.03%, p<0.01; 73.13% vs 89.09%, p<0.01 respectively), whereas the ratio of hemorrhagic transformation was much higher (16.42% vs 4.85%, p<0.01). In multivariable logistic regression, IR was negatively associated with neurological improvement and favorable functional prognosis (OR=0.39, 95%CI, 0.20-0.76, p<0.01; OR= 0.26, 95%CI, 0.07-0.91, p=0.04, respectively), but was positively correlated with hemorrhagic transformation (OR=4.07, 95%CI, 1.13-14.59, p=0.03) after adjusting traditional risk factors. We analyzed 108 infarct volume data further, the median of volume in IR group was 2.27 cm3, higher than that in non-IR group (1.96 cm3), but no statistical difference (p=0.65). CONCLUSIONS: In non-diabetic ischemic stroke patients treated with intravenous thrombolysis, IR was related with worse clinical outcomes, but not with infarct volume.
OBJECTIVES: to investigate the relationship between insulin resistance (IR) and clinical outcomes in non-diabetic ischemic strokepatients treated with intravenous thrombolysis. METHODS: We recruited non-diabetic ischemic strokepatients treated with intravenous thrombolysis prospectively. IR was defined as homeostasis model assessment-estimated insulin resistance index ≥2.80. Initial stroke severity was assessed using the National Institutes of Health Stroke Scale scores, and infarct volume was measured using DWI. Clinical outcomes were evaluated by neurological improvement and hemorrhagic transformation at 24 hours, and favorable functional prognosis at 90 days. RESULTS: 232 patients were enrolled into this study. IR group was 67 patients, non-IR group was 165 patients. Compared with the non-IR group, the probability of neurological improvement at 24 h ours and favorable functional outcome at 90 days in IR group were all significantly lower (41.79% vs 63.03%, p<0.01; 73.13% vs 89.09%, p<0.01 respectively), whereas the ratio of hemorrhagic transformation was much higher (16.42% vs 4.85%, p<0.01). In multivariable logistic regression, IR was negatively associated with neurological improvement and favorable functional prognosis (OR=0.39, 95%CI, 0.20-0.76, p<0.01; OR= 0.26, 95%CI, 0.07-0.91, p=0.04, respectively), but was positively correlated with hemorrhagic transformation (OR=4.07, 95%CI, 1.13-14.59, p=0.03) after adjusting traditional risk factors. We analyzed 108 infarct volume data further, the median of volume in IR group was 2.27 cm3, higher than that in non-IR group (1.96 cm3), but no statistical difference (p=0.65). CONCLUSIONS: In non-diabetic ischemic strokepatients treated with intravenous thrombolysis, IR was related with worse clinical outcomes, but not with infarct volume.