Akut iskemik inmede trigliserit-glikoz indeksi ile intravenöz trombolitik tedavi sonuçları arasındaki ilişki

Abstract

Amaç: Bu çalışmanın amacı, akut iskemik inme nedeniyle intravenöz trombolitik tedavi alan hastalarda insülin direncinin bir belirteci olan trigliserit glukoz indeksinin erken nörolojik kötüleşme (ENK), intraserebral kanama ve hemorajik transformasyon gelişimi ve mortalite üzerine etkisini araştırmaktır. Yöntem: Bu retrospektif çalışmaya akut iskemik inme nedeniyle intravenöz doku plazminojen aktivatörü (IV tPA) uygulanan 71 hasta dahil edildi. Demografik veriler, klinik ve radyolojik bulgular, açlık glukozu ve lipid profili, ENK, kanama gelişimi ve mortalite oranları analiz edildi. Trigliserid glukoz (TyG) indeksi hesaplanarak ve erken nörolojik bozulma, kanama gelişimi ve mortalite ile korelasyonu incelendi. Sonuç: Yaş ortancası 74 (41-88) olup, %54.9'u kadındı. İntraserebral hemoraji insidansı %9.6 iken, olguların %39.6'sında ENK meydana geldi ve 30 günlük mortalite oranı %28.2 idi. Ortalama TyG indeksi 7.8 (2.8-27.6) idi. ROC eğrisi analizi, TyG indeksinin 10.01'in üzerinde olan hastalarda %84.4 eğri altında kalan alan, %85 duyarlılık ve %82.35 özgüllük ile mortaliteyi öngördüğünü göstermiştir (p<0.01). Tek değişkenli analize göre, başvuru NIHSS skoru mortalite olasılığında 1,46 kat artışla (odds oranı [OR]: 1,459) ilişkiliyken, 10,01'den büyük bir TyG indeksi mortalite riskinde 1763,9 kat artışla (OR: 1763,9) ilişkiliydi (sırasıyla p=0,005; p=0,009). TyG indeksi daha yüksek olan hastalarda da mortalite ve ENK oranlarında anlamlı artış görülmüştür (her ikisi için de p<0.001). Hemoraji gelişimi ile TyG indeksi arasında bir ilişki bulunmamıştır (p>0.05). Sonuç: Bu çalışma, yüksek TyG indeksinin ENK ve mortalite ile ilişkili olduğunu ancak kanama gelişimi ile ilişkili olmadığını desteklemektedir. Daha geniş örneklemli çok merkezli çalışmalara ihtiyaç vardır.

Keywords

• Trigliserid glikoz indeksi
• insülin direnci
• intravenöz trombolitik tedavi
• akut iskemik inme
• hemorajik transformasyon

Relationship between triglyceride-glucose index and intravenous thrombolysis outcomes for acute ischemic stroke

Abstract

Aims: The aim of this study was to investigate the effect of triglyceride glucose index, a marker of insulin resistance, on early neurological deterioration (END), development of intracerebral hemorrhage and hemorrhagic transformation and mortality in patients receiving intravenous thrombolytic therapy for acute ischemic stroke. Methods: This retrospective study included 71 patients with acute ischemic stroke who received intravenous tissue plasminogen activator. Demographic data, clinical and radiological findings, fasting glucose and lipid profile, END, hemorrhage development and mortality rates were analyzed. We also calculated the triglyceride glucose (TyG) index and examined its correlation with early neurological deterioration, hemorrhage development and mortality. Results: The median age was 74 years (41-88), with a female predominance of 54.9%. The incidence of intracerebral hemorrhage was 9.6%, while END occurred in 39.6% of cases, and the 30-day mortality rate was 28.2%. The mean TyG index was 7.8 (2.8-27.6). The receiver operating characteristic curve analysis indicated that the TyG index predicted mortality with an area under the curve of 84.4%, a sensitivity of 85%, and a specificity of 82.35% in patients with a TyG index above 10.01 (p<0.01). According to univariate analyse, the admission NIHSS score was associated with a 1.46-fold increase in the odds of mortality (odds ratio [OR]: 1.459), while a TyG index greater than 10.01 was associated with a 1763.9-fold increase in mortality risk (OR: 1763.9) (p=0.005; p=0.009, respectively). Patients with higher TyG index also exhibited significantly increased rates of mortality and END (p<0.001 for both). There was no association between development of hemorrhage and TyG index (p>0.05). Conclusion: This study supports that a high TyG index is associated with END and mortality but not with the development of hemorrhage. Multicenter studies with larger sample size are needed.

Keywords

• Triglyceride glucose index
• insulin resistance
• intravenous thrombolytic therapy
• acute ischemic stroke
• hemorrhagic transformation

Supporting Institution

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Thanks

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