Skip to main content

Advertisement

SpringerLink
Log in

Insulin resistance is an independent risk factor for early neurological deterioration in non-diabetic patients with acute ischemic stroke

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Background

The role of insulin resistance (IR) in stroke prognosis remains largely unknown. This study aimed to investigate the relationship between IR and the risk of early neurological deterioration (END) in non-diabetic patients with acute ischemic stroke.

Methods

This is a retrospective analysis of non-diabetic patients with acute ischemic stroke enrolled in the prospective multicenter ACROSS-China study. The homeostasis model assessment 2 (HOMA2-IR) was evaluated and the patients were divided into HOMA2-IR quartiles (Q1 0–1.24, Q2 1.25–1.95, Q3 1.96–2.96, Q4 ≥ 2.97). END was defined as an increment in total National Institutes of Health Stroke Scale (NIHSS) of ≥ 2 points or ≥ 4 points on day 14 ± 3 after stroke onset. Logistic regression was performed to explore the relationship between HOMA2-IR and END.

Results

Finally, 556 patients were included (63.7 ± 12.9 years, 64.6% male); thirty-three patients developed END. The median HOMA2-IR of all patients was 1.95 (inter-quartile = 1.24–2.96). There were 148, 135, 130, and 143 patients in Q1, Q2, Q3, and Q4, respectively. Compared with Q1, END (NIHSS ≥ 2) risk was increased in Q4: adjusted odds ratio (OR) = 6.051, 95% CI = 1.638–22.354, P = 0.0069. In additon, END (NIHSS ≥ 2) risk was increased in Q4 compared with the Q1–Q3 combined group: adjusted OR = 2.853, 95% CI = 1.308–6.224, P = 0.0084. END (NIHSS ≥ 4) risk was also increased in Q4: adjusted OR = 7.507, 95% CI = 2.357–23.906, P = 0.0006) compared with the Q1–Q3 combined group.

Conclusion

This study strongly suggests that IR is probably an independent risk factor for END in non-diabetic patients with acute ischemic stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Johnston SC, Mendis S, Mathers CD (2009) Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 8(4):345–354

    Article  Google Scholar 

  2. Liu LP, Wong LK, Wang DZ, Miao ZR (2014) Current status of endovascular procedures in management of ischemic stroke in China. CNS Neurosci Ther 20(6):483–484

    Article  Google Scholar 

  3. Liu L, Wang D, Wong KS, Wang Y (2011) Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke 42(12):3651–3654

    Article  Google Scholar 

  4. Li H, Qiu W, Hu B, Kang Z, Wu AM, Dai Y, Lin Y, Lu Z (2013) Ischemic volumes and early neurologic deterioration in acute brainstem infarctions with hemoglobin A1c. Eur Neurol 70(3–4):225–232

    Article  CAS  Google Scholar 

  5. Kwon HM, Lim JS, Park HK, Lee YS (2011) Hypertriglyceridemia as a possible predictor of early neurological deterioration in acute lacunar stroke. J Neurol Sci 309(1–2):128–130

    Article  Google Scholar 

  6. Simonsen CZ, Schmitz ML, Madsen MH, Mikkelsen IK, Chandra RV, Leslie-Mazwi T, Andersen G (2016) Early neurological deterioration after thrombolysis: clinical and imaging predictors. Int J Stroke 11(7):776–782

    Article  Google Scholar 

  7. Bhatia K, Mohanty S, Tripathi BK, Gupta B, Mittal MK (2015) Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity. Indian J Med Res 141(3):299–307

    Article  Google Scholar 

  8. Bas DF, Ozdemir AO, Colak E, Kebapci N (2016) Higher insulin resistance level is associated with worse clinical response in acute ischemic stroke patients treated with intravenous thrombolysis. Transl Stroke Res 7(3):167–171

    Article  CAS  Google Scholar 

  9. Mi D, Zhang L, Wang C, Liu L, Pu Y, Zhao X, Wang Y, Wang Y (2012) Impact of metabolic syndrome on the prognosis of ischemic stroke secondary to symptomatic intracranial atherosclerosis in Chinese patients. PLoS One 7(12):e51421

    Article  CAS  Google Scholar 

  10. Jia Q, Zheng H, Zhao X, Wang C, Liu G, Wang Y, Liu L, Li H, Zhong L, Wang Y, Investigators for the Survey on Abnormal Glucose Regulation in Patients With Acute Stroke Across China (ACROSS-China) (2012) Abnormal glucose regulation in patients with acute stroke across China: prevalence and baseline patient characteristics. Stroke 43(3):650–657

    Article  CAS  Google Scholar 

  11. Jia Q, Liu G, Zheng H, Zhao X, Wang C, Wang Y, Liu L, Wang Y, Investigators for the Survey on Abnormal Glucose Regulation in Patients With Acute Stroke Across China (2014) Impaired glucose regulation predicted 1-year mortality of Chinese patients with ischemic stroke: data from abnormal glucose regulation in patients with acute stroke across China. Stroke 45(5):1498–1500

    Article  Google Scholar 

  12. Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke, 1989. 20(10): p. 1407–31

  13. Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15(7):539–553

    Article  CAS  Google Scholar 

  14. American Diabetes A (2006) Diagnosis and classification of diabetes mellitus. Diabetes Care 29(Suppl 1):S43–S48

    Google Scholar 

  15. Wallace TM, Levy JC, Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27(6):1487–1495

    Article  Google Scholar 

  16. Jeong HG, Kim BJ, Yang MH, Han MK, Bae HJ (2015) Neuroimaging markers for early neurologic deterioration in single small subcortical infarction. Stroke 46(3):687–691

    Article  CAS  Google Scholar 

  17. Zhang X et al (2016) Metabolic syndrome augments the risk of early neurological deterioration in acute ischemic stroke patients independent of inflammatory mediators: a hospital-based prospective study. Oxidative Med Cell Longev 2016:8346301

    Google Scholar 

  18. Seners P, Turc G, Tisserand M, Legrand L, Labeyrie MA, Calvet D, Meder JF, Mas JL, Oppenheim C, Baron JC (2014) Unexplained early neurological deterioration after intravenous thrombolysis: incidence, predictors, and associated factors. Stroke 45(7):2004–2009

    Article  CAS  Google Scholar 

  19. Calleja, A.I., et al., Blood biomarkers of insulin resistance in acute stroke patients treated with intravenous thrombolysis: temporal profile and prognostic value.J Diab Res Clin Metab, 2013

    Google Scholar 

  20. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease (2014) Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45(7):2160–2236

    Article  Google Scholar 

  21. Kaur J (2014) A comprehensive review on metabolic syndrome. Cardiol Res Pract 2014:943162

    PubMed  PubMed Central  Google Scholar 

  22. Janszky I, Hallqvist J, Ljung R, Ahlbom A, Hammar N (2009) Prognostic role of the glucometabolic status assessed in a metabolically stable phase after a first acute myocardial infarction: the SHEEP study. J Intern Med 265(4):465–475

    Article  CAS  Google Scholar 

  23. Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, Guarino PD, Lovejoy AM, Peduzzi PN, Conwit R, Brass LM, Schwartz GG, Adams HP Jr, Berger L, Carolei A, Clark W, Coull B, Ford GA, Kleindorfer D, O’Leary JR, Parsons MW, Ringleb P, Sen S, Spence JD, Tanne D, Wang D, Winder TR, IRIS Trial Investigators (2016) Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med 374(14):1321–1331

    Article  CAS  Google Scholar 

  24. Davalos A et al (1999) Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European cooperative acute stroke study (ECASS) I. Stroke 30(12):2631–2636

    Article  CAS  Google Scholar 

  25. Kwan J, Hand P (2006) Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM 99(9):625–633

    Article  CAS  Google Scholar 

  26. DeGraba TJ et al (1999) Progression in acute stroke: value of the initial NIH stroke scale score on patient stratification in future trials. Stroke 30(6):1208–1212

    Article  CAS  Google Scholar 

  27. Ois A, Martinez-Rodriguez JE, Munteis E, Gomis M, Rodríguez-Campello A, Jimenez-Conde J, Cuadrado-Godia E, Roquer J (2008) Steno-occlusive arterial disease and early neurological deterioration in acute ischemic stroke. Cerebrovasc Dis 25(1–2):151–156

    Article  Google Scholar 

  28. Vila N, Castillo J, Dávalos A, Chamorro A (2000) Proinflammatory cytokines and early neurological worsening in ischemic stroke. Stroke 31(10):2325–2329

    Article  CAS  Google Scholar 

  29. Seo WK, Seok HY, Kim JH, Park MH, Yu SW, Oh K, Koh SB, Park KW (2012) C-reactive protein is a predictor of early neurologic deterioration in acute ischemic stroke. J Stroke Cerebrovasc Dis 21(3):181–186

    Article  Google Scholar 

  30. Calleja AI, García-Bermejo P, Cortijo E, Bustamante R, Rojo Martínez E, González Sarmiento E, Fernández-Herranz R, Arenillas JF (2011) Insulin resistance is associated with a poor response to intravenous thrombolysis in acute ischemic stroke. Diabetes Care 34(11):2413–2417

    Article  CAS  Google Scholar 

  31. Wang Q, Chen C, Chen XY, Han JH, Soo Y, Leung TW, Mok V, Wong KS (2012) Low-molecular-weight heparin and early neurologic deterioration in acute stroke caused by large artery occlusive disease. Arch Neurol 69(11):1454–1460

    Article  Google Scholar 

  32. Awadh M, MacDougall N, Santosh C, Teasdale E, Baird T, Muir KW (2010) Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke: incidence and association with atrial fibrillation. Stroke 41(9):1990–1995

    Article  Google Scholar 

  33. Seners P et al (2015) Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications. J Neurol Neurosurg Psychiatry 86(1):87–94

    Article  Google Scholar 

  34. Duan Z, Fu C, Chen B, Xu G, Tao L, Tang T, Hou H, Fu X, Yang M, Liu Z, Zhang X (2015) Lesion patterns of single small subcortical infarct and its association with early neurological deterioration. Neurol Sci 36(10):1851–1857

    Article  Google Scholar 

  35. Siegler JE, Martin-Schild S (2011) Early neurological deterioration (END) after stroke: the END depends on the definition. Int J Stroke 6(3):211–212

    Article  Google Scholar 

Download references

Availability of data and materials

The data sets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Funding

This study was supported by the National Natural Science Foundation of China (81601015) and Beijing Talents Fund (2015000021469G220).

Author information

Authors and Affiliations

  1. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Donghua Mi, Yilong Wang, Yongjun Wang & Liping Liu

  2. China National Clinical Research Center for Neurological Diseases, Beijing, China

    Donghua Mi, Yilong Wang, Yongjun Wang & Liping Liu

  3. Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China

    Donghua Mi, Yilong Wang, Yongjun Wang & Liping Liu

  4. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China

    Donghua Mi, Yilong Wang, Yongjun Wang & Liping Liu

  5. Beijing, China

    Liping Liu

Authors
  1. Donghua Mi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yilong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yongjun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liping Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mi, D., Wang, Y., Wang, Y. et al. Insulin resistance is an independent risk factor for early neurological deterioration in non-diabetic patients with acute ischemic stroke. Neurol Sci 41, 1467–1473 (2020). https://doi.org/10.1007/s10072-019-04221-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-019-04221-7

Keywords

Search

Navigation