title: Higher Insulin Resistance Level is Associated with Worse Clinical Response in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis.
abstract: Insulin resistance is linked to atherosclerotic cardiovascular diseases and stroke. We investigated whether there is a relationship between insulin resistance and clinical findings and outcomes of acute ischemic stroke patients treated with intravenous thrombolysis. In our study, 180 acute ischemic stroke non-diabetic patients treated with intravenous recombinant tissue-type plasminogen activator (iv rt-PA) were evaluated for insulin resistance assessed by homeostasis model assessment insulin resistance (HOMA-IR). The threshold for HOMA-IR was determined as 2.7. Patients were grouped as HOMA-IR > 2.7 and HOMA-IR ≤ 2.7. Clinical features at baseline, 24th hour, and 3rd month were examined. Computed tomography (CT) findings for hemorrhagic transformation were also assessed. Patients with HOMA-IR > 2.7 had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores at 24th hour (p = 0.005) and higher modified Rankin Scale (mRS) scores at 3rd month (p = 0.011). Logistic regression analysis displayed that the presence of HOMA-IR > 2.7 increases the likelihood of poor outcome 2.93 times (confidence interval [CI] 1.001-1.079) (p = 0.003). There was no statistically significant difference between baseline clinical features, hemorrhagic transformation (p = 1.000), and mortality (p = 0.350) rates. Insulin resistance at higher levels seems to be associated with poor clinical courses and outcomes in patients who received iv rt-PA.
authors.affiliation: Department of Neurology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey. demetf@gmail.com.
authors.forename: Demet Funda
authors.identifier: 0000-0001-9231-0337
authors.initials: DF
authors.lastname: Bas
authors.affiliation: Department of Neurology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
authors.forename: Atilla Ozcan
authors.initials: AO
authors.lastname: Ozdemir
authors.affiliation: Department of Biostatistics and Medical Informatics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
authors.forename: Ertuğrul
authors.initials: E
authors.lastname: Colak
authors.affiliation: Department of Endocrinology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
authors.forename: Nur
authors.initials: N
authors.lastname: Kebapci
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; Homeostasis model assessment insulin resistance (HOMA-IR); Insulin; Recombinant tissue-type plasminogen activator (rt-PA)
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