Insulin resistance and clinical outcomes after acute ischemic stroke.

Abstract

OBJECTIVE:

In this study, we aimed to determine whether insulin resistance is associated with clinical outcomes after acute ischemic stroke.

METHODS:

We enrolled 4,655 patients with acute ischemic stroke (aged 70.3 ± 12.5 years, 63.5% men) who had been independent before admission; were hospitalized in 7 stroke centers in Fukuoka, Japan, from April 2009 to March 2015; and received no insulin therapy during hospitalization. The homeostasis model assessment of insulin resistance (HOMA-IR) score was calculated using fasting blood glucose and insulin levels measured 8.3 ± 7.8 days after onset. Study outcomes were neurologic improvement (≥4-point decrease in NIH Stroke Scale score or 0 at discharge), poor functional outcome (modified Rankin Scale score of ≥3 at 3 months), and 3-month prognosis (stroke recurrence and all-cause mortality). Logistic regression analysis was used to evaluate the association of the HOMA-IR score with clinical outcomes.

RESULTS:

The HOMA-IR score was associated with neurologic improvement (odds ratio, 0.68 [95% confidence interval, 0.56-0.83], top vs bottom quintile) and with poor functional outcome (2.02 [1.52-2.68], top vs bottom quintile) after adjusting for potential confounding factors, including diabetes and body mass index. HOMA-IR was not associated with stroke recurrence or mortality within 3 months of onset. The associations were maintained in nondiabetic or nonobese patients. No heterogeneity was observed according to age, sex, stroke subtype, or stroke severity.

CONCLUSIONS:

These findings suggest that insulin resistance is independently associated with poor functional outcome after acute ischemic stroke apart from the risk of short-term stroke recurrence or mortality.

• Authors: Tetsuro Ago, Ryu Matsuo, Jun Hata, Yoshinobu Wakisaka, Junya Kuroda, Takanari Kitazono, Masahiro Kamouchi, Fukuoka Stroke Registry Investigators
• Journal: Neurology (Neurology) Vol. 90 Issue 17 Pg. e1470-e1477 (04 24 2018) ISSN: 1526-632X [Electronic] United States
• PMID: 29602916 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 American Academy of Neurology.

Chemical References

• Blood Glucose

Topics

• Aged
• Aged, 80 and over
• Blood Glucose (metabolism)
• Brain Ischemia (complications)
• Fasting
• Female
• Hospitalization
• Humans
• Insulin Resistance (physiology)
• Japan
• Male
• Middle Aged
• Neuroimaging
• Outcome Assessment, Health Care
• Retrospective Studies
• Severity of Illness Index
• Stroke (diagnostic imaging, etiology, therapy)
• Treatment Outcome