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Homeostasis model assessment of insulin resistance and outcome of ischemic stroke in non-diabetic patients - a prospective observational study

Journal article
Authors Daniel Åberg
N David Åberg
Katarina Jood
Lukas Holmegaard
Petra Redfors
Christian Blomstrand
Jörgen Isgaard
Christina Jern
Johan Svensson
Published in BMC Neurol
Volume 19
ISSN 1471-2377
Publication year 2019
Published at Institute of Neuroscience and Physiology
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Language en
Links dx.doi.org/10.1186/s12883-019-1406-...
Keywords Insulin resistance, HOMA-IR, Ischemic stroke, Modified Rankin scale, of-health stroke, metabolic syndrome, admission hyperglycemia, sahlgrenska-academy, scandinavian stroke, genetic-variation, blood-glucose, risk-factors, association, prognosis, Neurosciences & Neurology
Subject categories Internal medicine

Abstract

BackgroundInsulin resistance (IR) in relation to diabetes is a risk factor for ischemic stroke (IS), whereas less is known about non-diabetic IR and outcome after IS.MethodsIn non-diabetic IS (n=441) and controls (n=560) from the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS), IR was investigated in relation to IS severity and functional outcome. IR was evaluated acutely and after 3months using the Homeostasis model assessment of IR (HOMA-IR). Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS). Functional outcome was evaluated using the modified Rankin Scale (mRS) after 3months, 2 and 7years. Associations were evaluated by logistic regression.ResultsHigher acute and 3-month HOMA-IR was observed in IS compared to the controls (both p<0.001) and in severe compared to mild IS (both p<0.05). High acute HOMA-IR was associated with poor outcome (mRS 3-6) after 3months and 7years [crude Odds ratios (ORs), 95% confidence intervals (CIs) 1.50, 1.07-2.11 and 1.59, 1.11-2.30, respectively], but not after 2years. These associations lost significance after adjustment for all covariates including initial stroke severity. In the largest IS subtype (cryptogenic stroke), acute HOMA-IR was associated with poor outcome after 2years also after adjustment for age and stroke severity (OR 2.86, 95% CI 1.01-8.12).ConclusionsIn non-diabetic IS patients, HOMA-IR was elevated and related to stroke severity, but after adjustment for IS severity, the associations between HOMR-IR and poor outcome lost significance. This could suggest that elevated IR mostly is a part of the acute IS morbidity. However, in the subgroup of cryptogenic stroke, the associations with poor outcome withstood correction for stroke severity.

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