Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Insulin Resistance Index from OGTT Predicts Ischemic Stroke Outcomes in Non-Diabetic Patients with Different eGFR Strata
First author：Yilun Zhou,Zhang Yin,Yuesong Pan
Corresponding author：Yongjun Wang
essential_information
- Person in charge：Yilun Zhou,Zhang Yin,Yuesong Pan
- Data Sources： ACROSS-CHINA
- Number of papers：ACROSS-CHINA20190058
- Published time：2018-03-15
2018-03-15
Published articles
Journal：Cerebrovasc Dis
Publication type: Original Contributions
IF(IF): 2.762
PMID: 30235440 Link To Pubmed Full text Download
Background And Purpose
Insulin resistance is associated with cardiovascular morbidity and mortality in the general population. However, the relationship between insulin resistance and health outcomes is controversial in patients with impaired renal function. Our study aimed to investigate the association between insulin resistance and prognosis in a cohort of nondiabetic stroke patients with different estimated glomerular filtration rate (eGFR) strata.
Method
Data were derived from Abnormal Glucose Regulation in Patients with Acute Stroke across China (ACROSS-China) registry. Ischemic stroke patients without history of diabetes were included. Fasting and oral glucose tolerance test (OGTT)-derived measures of insulin resistance were calculated along with homeostasis model assessment of insulin resistance (HOMA-IR) and composite insulin sensitivity index (ISI). Insulin resistance was defined by the highest HOMA-IR quartile (Q4) and the lowest composite ISI quartile (Q1).
Conclusion
An OGTT-derived estimate of insulin resistance with the composite ISI, but not HOMA-IR, was independently associated with increased risks of 1-year mortality and poor functional outcome in non-diabetic ischemic stroke patients with different eGFR strata.
Main results
Among 1,196 patients, HOMA-IR Q4 (insulin resistance) vs. Q1–3 was associated with increased 1-year mortality (adjusted hazards ratio [HR] 1.83, 95% CI 1.07–3.13) and poor functional outcome (adjusted OR 1.97, 95% CI 1.32–2.95) only in participants with an eGFR ≥90 mL/min/1.73 m2. By comparison, composite ISI Q1 (insulin resistance) vs. Q2–4 was associated with higher risks of 1-year mortality (adjusted HR 3.64, 0.90–14.78; 2.50, 1.19–5.26; and 1.99, 1.17–3.39, respectively) and poor functional outcome (adjusted OR 3.62, 1.08–12.19; 1.51, 0.85–2.70; and 2.25, 1.42–3.57, respectively) in all 3 subgroups with eGFR < 60, 60–89, and ≥90 mL/min/1.73 m2.