A Novel Metabolic Score for Insulin Resistance and Symptomatic Intracranial Hemorrhage in Ischemic Stroke Patients After Endovascular Thrombectomy

Shuaiyu Chen; Yan E; Xiaohao Zhang; Bin Wei; Siyu Wang; Zhaohan Xu; Pengyu Gong; Yi Xie; Chunhua Qin; Yingdong Zhang

doi:10.2147/NDT.S394438

A Novel Metabolic Score for Insulin Resistance and Symptomatic Intracranial Hemorrhage in Ischemic Stroke Patients After Endovascular Thrombectomy

Neuropsychiatr Dis Treat. 2023 Feb 5:19:321-328. doi: 10.2147/NDT.S394438. eCollection 2023.

Authors

Shuaiyu Chen^#¹, Yan E^#¹, Xiaohao Zhang^#¹, Bin Wei¹, Siyu Wang¹, Zhaohan Xu¹, Pengyu Gong², Yi Xie³, Chunhua Qin¹, Yingdong Zhang¹

Affiliations

¹ Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.
² Department of Neurology, Affiliated Hospital of Nantong University, Nantong, People's Republic of China.
³ Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.

^# Contributed equally.

Abstract

Background and purpose: Insulin resistance plays a pivotal role in the pathophysiology of ischemic stroke. This study aimed to determine the relationship between the novel metabolic score for insulin resistance (METS-IR) and symptomatic intracranial hemorrhage (sICH) after endovascular thrombectomy (EVT) in stroke patients.

Methods: We retrospectively included patients with large artery occlusion in the anterior circulation and treated by EVT from 2 stroke centers (Nanjing First Hospital from September 2019 to April 2022, and Jinling Hospital from September 2019 to July 2021). The METS-IR was used as an alternative marker of insulin resistance and calculated using laboratory data after admission. sICH was diagnosed according to the Heidelberg Bleeding Classification.

Results: Of the 410 enrolled patients (mean age, 69.8 ± 11.7 years; 60.7% men), 50 (12.2%) were diagnosed as sICH. After adjusting for demographic characteristics, poor collateral status, and other potential confounders, higher METS-IR was revealed to be independently associated with sICH (odds ratio, 1.076; 95% confidence interval, 1.034-1.120; P = 0.001). Similar significant results were obtained when defining METS-IR as a categorical variable. The restricted cubic spline uncovered a linear relationship between METS-IR and sICH (P < 0.001 for linearity). Furthermore, adding METS-IR to the conventional model significantly improved the risk prediction for sICH (net reclassification improvement = 15.8%, P = 0.035; integrated discrimination index = 2.6%; P = 0.017).

Conclusion: This study demonstrated a significant association between METS-IR score and sICH in ischemic stroke patients treated with EVT. It could help monitor and manage sICH in patients after EVT.

Keywords: METS-IR; endovascular thrombectomy; insulin resistance; ischemic stroke; symptomatic intracranial hemorrhage.

Grants and funding

This work was supported by the National Science and Technology Innovation 2030-Major program of “Brain Science and Brain-Inspired Intelligence Research” (2021ZD0201807), and Medical Innovation Team of Jiangsu Province (CXTDA2017030).