Evaluation of four insulin resistance surrogate indicators for predicting short-term mortality in critically ill patients with ischemic stroke: a nationwide retrospective cohort study
Authors' conclusion
Four surrogate indices of IR were positively associated with short-term mortality risk in critically ill patients with IS. Among these indices, TyG and METS-IR demonstrated relatively stronger risk effects, while the AIP exhibited superior effect size and discriminative ability in patients under 60 years of age. In contrast, TyG-BMI displayed comparatively weaker performance both in the overall population and across subgroups. These findings address a critical gap in understanding the comparative utility of surrogate IR indices for assessing short-term mortality risk in severe IS. Routine evaluation of these indices may enhance clinical assessment and inform individualized patient management across different subgroups. Furthermore, incorporating robust indicators such as TyG into clinical risk assessment models could enhance the precision of mortality predictions and facilitate optimized patient management strategies.
Study context
- Population
- Critically ill patients with ischemic stroke, eICU database; 52.60% female
- Participants
- 1,346 patients
- Exposure
- Four insulin resistance (IR) surrogate indices for 28-day in-hospital mortality
- Outcome
- 28-day in-hospital mortality
- Follow-up
- 28 days
Methodological detailsnationwide, eICU database
- Nationwide
- eICU database
Main finding
As reported in the abstract
| Group | HR |
|---|---|
| TyG | 1.44 |
| Metabolic score for insulin resistance (METS-IR) | 1.41 |
HR
- Overall 28-day mortality rate
- 8.77%
Observational data: associations, not effects.
Further findings
Mortality, TyG in males
| HR (95% CI) | P value | ||
|---|---|---|---|
| TyGMales | 1.49 (1.17–1.90) | P = 0.0013 | |
| 0.512Hazard ratio (log scale) |
Mortality, atherogenic index of plasma (AIP) in patients <60 years
| HR (95% CI) | P value | ||
|---|---|---|---|
| AIPUnder 60 years | 1.58 (1.07–2.32) | P = 0.0204 | |
| 0.512Hazard ratio (log scale) |
| Outcome | AIP |
|---|---|
| Discrimination in patients <60 years | |
| AUC | 0.68 |
Mortality by sex · 28 days
- No significant differences in 28-day mortality between genders
Discrimination in patients <60 years
- AIP showed stronger discriminative ability than other indices in patients <60 years
Interactions by sex or age
- No significant interactions across sex or age subgroups for the four indices
Original publication
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