Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

Journal：BMC Neurology

Publication type: Original Contributions

IF(IF): 2.6

PMID: 42458296 Link To Pubmed Full text Download

Insulin resistance (IR) promotes inflammation, induces oxidative stress, and impairs endothelial function, thereby accelerating thrombosis and atherosclerosis and increasing the risk of stroke and cardiovascular events. The triglyceride-glucose (TyG) index, introduced in 2008, has been widely adopted as a reliable surrogate marker of IR in clinical practice. Accumulating evidence indicates that the TyG index is strongly associated with atherosclerosis, stroke, and adverse cardiovascular outcomes. Inflammation further contributes to stroke risk by promoting atherosclerosis, impairing endothelial function, and enhancing thrombus formation. Ryan et al. first proposed the CRP–Triglyceride–Glucose (CTI) index, which integrates IR and inflammation, demonstrating favorable predictive performance for cancer-related mortality in both cancer cachexia and the general population, as well as for the diagnosis of coronary heart disease. A recent study published in Cardiovascular Diabetology reported a significant positive linear relationship between CTI and the incidence of stroke. High-sensitivity C-reactive protein (hsCRP) has been consistently associated with stroke and cardiovascular events. In this study, we propose the high-sensitivity CRP–Triglyceride–Glucose (hsCTI) index, which combines IR and hsCRP, with the aim of improving identification of high-risk individuals and serving as a reliable tool for early prediction and personalized intervention for stroke and cardiovascular events.

Participants were categorized into four groups according to the quartiles of hsCTI. Cox proportional hazards regression was used to assess the associations of hsCTI with stroke recurrence and all-cause mortality, with results presented as HRs and 95% CIs. Models were adjusted for age, sex, smoking status, alcohol consumption, BMI, medical history, and prior medication use. Restricted cubic spline analyses were performed to explore potential non-linear relationships and threshold effects of hsCTI on stroke recurrence and all-cause mortality. Kaplan–Meier curves and the log-rank test were used to evaluate stroke incidence. Subgroup analyses were conducted based on age, sex, BMI, diabetes status, and baseline NIHSS scores to further investigate the relationship between hsCTI and stroke recurrence or all-cause mortality. Additionally, the associations of hsCTI with stroke risk were examined across different strata of sex, age, and blood glucose levels. To capture long-term hsCTI patterns, we calculated the updated cumulative average hsCTI index using all available measurements at baseline, 3 months, and 1 year, with the values carried forward until the occurrence of the outcome of interest or the end of follow-up.