Insulin Resistance Predicts Prognosis in Patients With Subarachnoid Hemorrhage

IF 3.6 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Evidence‐Based Medicine Pub Date : 2024-12-15 DOI:10.1111/jebm.12660

Pengfei Ding, Dingding Zhang, Haiping Ling, Tao Tao, Yongyue Gao, Yunfeng Wang, Huasheng Zhang, Lingyun Wu, Chunhua Hang, Wei Li

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Abstract

Objective

The objective of this study was to determine whether insulin resistance (IR) could be used as a predictor of poor prognosis at 3 months after subarachnoid hemorrhage (SAH).

Methods

The study included patients aged 18 years or older with a confirmed diagnosis of SAH due to ruptured aneurysm from January 2021 to March 2024. Patients with confirmed diabetes mellitus and taking glucose-lowering drugs, or taking lipid-lowering drugs, or SAH not due to ruptured aneurysm, or comorbid systemic diseases were excluded. Patients were classified into good prognosis (modified Rankin scale [MRS] 0–2) and poor prognosis (MRS 3–6). Receiver operating characteristic curve (ROC), least absolute shrinkage and selection operator (LASSO) analysis, and multivariate logistic regression analysis were used to determine the potential of triglyceride-glucose (TyG) index and the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio as predictors of poor prognosis. Finally, a prognostic prediction model based on IR was constructed.

Results

A total of 358 patients were included in this study. Poor prognosis patients had higher age, BMI, hypertension percentage, glucose, triglycerides, TyG index and TG/HDL ratio, and lower HDL. ROC, LASSO, and multivariate logistic regression analysis revealed that age, glucose, TyG index, and TG/HDL ratio had significant potential to predict the prognosis of SAH patients. The prognostic prediction model constructed by combining age, glucose, TyG index, and TG/HDL ratio had high discriminatory power (area under the curve [AUC] = 0.80), satisfactory calibration curves, and good clinical utility.

Conclusion

IR is strongly associated with the prognosis of SAH patients, and the combination of age, glucose, TyG index, and TG/HDL ratio can provide a new direction for future treatment.

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胰岛素抵抗预测蛛网膜下腔出血患者的预后。

研究目的本研究旨在确定胰岛素抵抗（IR）是否可作为蛛网膜下腔出血（SAH）后3个月预后不良的预测指标：研究对象包括2021年1月至2024年3月期间确诊为动脉瘤破裂导致的蛛网膜下腔出血的18岁或18岁以上患者。排除确诊为糖尿病且正在服用降糖药物或降脂药物的患者，或非动脉瘤破裂导致的 SAH 患者，或合并全身性疾病的患者。患者被分为预后良好（改良Rankin量表[MRS] 0-2）和预后不良（MRS 3-6）两类。采用接收者操作特征曲线（ROC）、最小绝对缩小和选择算子（LASSO）分析和多变量逻辑回归分析来确定甘油三酯-葡萄糖（TyG）指数和甘油三酯与高密度脂蛋白胆固醇（TG/HDL）比值作为预后不良预测因子的潜力。最后，构建了基于 IR 的预后预测模型：本研究共纳入 358 例患者。预后不良患者的年龄、体重指数、高血压比例、血糖、甘油三酯、TyG 指数和 TG/HDL 比值均较高，高密度脂蛋白较低。ROC、LASSO和多变量逻辑回归分析表明，年龄、血糖、TyG指数和TG/HDL比值在预测SAH患者预后方面具有显著潜力。结合年龄、血糖、TyG 指数和 TG/HDL 比率构建的预后预测模型具有较高的判别能力（曲线下面积 [AUC] = 0.80）、令人满意的校准曲线和良好的临床实用性：IR与SAH患者的预后密切相关，结合年龄、血糖、TyG指数和TG/HDL比值可为未来的治疗提供新的方向。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.