The triglyceride-to-admission glucose ratio as an independent predictor of poor outcome after ischemic stroke

Objective: The serum triglyceride to glucose ratio (TGR) has been shown a reliable surrogate index to screen for risk of insulin resistance, and a marker of high risk in subjects with cardiovascular disease. The gradient of arterial stiffness, as reflected by the pulse wave velocity (PWV) ratio, has been found to be independently related with poor outcome in patients with acute ischemic stroke (AIS). The aim of the study was to assess the relationship between TGR and stroke severity and to evaluate its potential role as a predictor of functional outcome in patients with AIS. Design and method: We enrolled 150 AIS patients (115 males, age 63.1 ± 12.4 years, median NIHSS score 6(3 - 8) points). Carotid-femoral and radial–carotid PWV were measured (SphygmoCor®) within several (6 ± 2) days after stroke onset. TGR was calculated by dividing fasting serum triglycerides by admission glucose. Functional outcome was evaluated 90 days after stroke using the modified Rankin Scale (mRS) with an mRS score of 3 to 6 (dependency or death) considered as a poor outcome. Results: TGR was significantly lower, while admission glucose was significantly higher in patients with poor compared to those with good functional outcome (0.87 ± 0.63 vs 1.14 ± 0.68; p = 0.02, and 168.4 ± 71.1 vs 132.5 ± 56.0 mg/dL; p = 0.001, respectively). In a multivariate analysis, TGR was significantly associated with functional outcome after controlling for age, sex, PWV ratio, stroke severity and use of rtPA (adjusted OR = 0.31; 95% CI, 0.11 - 0.91; p = 0.03), while glucose was not (adjusted OR = 1.00; 95% CI, 1.00 - 1.01; p = 0.07). Conclusions: Triglyceride-to-glucose ratio might be a useful predictor of functional outcome in patients with acute ischemic stroke, independent of traditional and new vascular factors, including arterial stiffness gradient.