Evaluation of four insulin resistance surrogate indicators for predicting short-term mortality in critically ill patients with ischemic stroke: a nationwide retrospective cohort study

Cardiovasc DiabetolPublished 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

28-day mortality
GroupHR
TyG1.44
Metabolic score for insulin resistance (METS-IR)1.41

HR

TyG1.44
Metabolic score for insulin resistance (METS-IR)1.41
Overall 28-day mortality rate
8.77%

Observational data: associations, not effects.

Further findings

Mortality, TyG in males

HR (95% CI)P value
TyGMales1.49 (1.17–1.90)P = 0.0013

Mortality, atherogenic index of plasma (AIP) in patients <60 years

HR (95% CI)P value
AIPUnder 60 years1.58 (1.07–2.32)P = 0.0204
OutcomeAIP
Discrimination in patients <60 years
AUC0.68

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

Evaluation of four insulin resistance surrogate indicators for predicting short-term mortality in critically ill patients with ischemic stroke: a nationwide retrospective cohort study. Cardiovasc Diabetol. Published 28 October 2025. doi:10.1186/s12933-025-02956-6

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