Association of various insulin resistance surrogate markers with mortality risk in critically ill patients with ischemic stroke: a retrospective cohort study.

BACKGROUND

Ischemic stroke poses a substantial global health burden and represents one of the leading causes of death and disability. Insulin resistance (IR), a core feature of metabolic dysfunction, is recognized to play a critical role in the pathogenesis and progression of ischemic stroke. However, the predictive value of different surrogate markers of IR for mortality in patients with ischemic stroke remains unclear.

METHODS

Using the public eICU-CRD database, we screened 1709 critically ill patients with ischemic stroke admitted to the intensive care unit (ICU). Patients were stratified by quartiles according to 8 distinct IR surrogate markers. The primary endpoint was in-hospital mortality. Statistical analyses included Cox regression, Kaplan-Meier curves, and restricted cubic spline (RCS) models.

RESULTS

Among the 1709 ICU-admitted patients, 437 deaths occurred, with an in-hospital mortality rate of 25.57%. Multivariable Cox regression analyses demonstrated that all IR surrogate markers were significantly associated with mortality risk in patients with ischemic stroke. TyG-derived indices, TG-HDL, METS-IR, AIP, and CHG were positively correlated with mortality, whereas SPISE showed an inverse association (all P for trend < 0.05). Kaplan-Meier curves confirmed the associations between the 8 IR surrogate markers and in-hospital mortality. RCS analyses revealed nonlinear relationships between SPISE, TG-HDL, METS-IR, TyG-BMI, TyG-RC, CHG and all-cause mortality.

CONCLUSION

Multiple IR surrogate markers independently predict in-hospital mortality in critically ill patients with ischemic stroke. Incorporation of these indices into risk stratification may facilitate early identification and targeted intervention for high-risk individuals.