Neuropsychiatric Disease and Treatment (Feb 2023)

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

  • Chen S,
  • E Y,
  • Zhang X,
  • Wei B,
  • Wang S,
  • Xu Z,
  • Gong P,
  • Xie Y,
  • Qin C,
  • Zhang Y

Journal volume & issue
Vol. Volume 19
pp. 321 – 328

Abstract

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Shuaiyu Chen,1,* Yan E,1,* Xiaohao Zhang,1,* Bin Wei,1 Siyu Wang,1 Zhaohan Xu,1 Pengyu Gong,2 Yi Xie,3 Chunhua Qin,1 Yingdong Zhang1 1Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Neurology, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China; 3Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chunhua Qin; Yingdong Zhang, Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, People’s Republic of China, Tel/Fax +86 2552271000, Email [email protected]; [email protected] 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, insulin resistance, ischemic stroke, symptomatic intracranial hemorrhage, endovascular thrombectomy

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