Association between the triglyceride-glucose index and functional outcome at discharge in patients receiving standardized treatment for atherosclerotic and cardioembolic stroke

Abstract

The triglyceride-glucose (TyG) index is gaining considerable attention as an emerging marker of metabolic syndrome. The TyG index is strongly associated with atherosclerosis and cardiovascular disease development. However, the impact of the TyG index on the functional outcome at discharge of patients receiving standardized treatment and its variability in different types of stroke have not been fully elucidated. Baseline data, neurological scale scores, and laboratory indicators were retrospectively collected from ischemic stroke patients at Lianyungang Second People’s Hospital and Lianyungang First People’s Hospital. Patients were categorized into good and poor functional outcome groups based on the modified Rankin Scale (mRS) score at discharge. A logistic regression model was used to evaluate the relationship between the TyG index and functional outcome at discharge of patients with atherosclerotic and cardioembolic stroke. A total of 854 patients were included in the analysis, including 712 patients with large artery atherosclerotic (LAA) and 142 patients with cardioembolism (CE). Subgroup comparisons based on different discharge-level functional outcomes showed that the TyG index of the 187 patients in the poor functional outcome at discharge group was higher than that of patients in the good functional outcome group (8.98 vs. 8.69). The restricted cubic curve revealed a nonlinear association between the TyG index and discharge-level functional outcome among LAA stroke patients (for nonlinearity, p = 0.026). Multivariate logistic regression showed that the TyG-Q2 and TyG-Q3 groups were not associated with discharge-level functional outcome compared with the TyG-Q1 group, and the TyG-Q4 group was a risk factor for the occurrence of poor functional in the LAA group (odds ratio (OR) = 2.63, 95% confidence interval (CI) = 1.52–4.55). After adjusting for age, National Institute of Health Stroke Scale (NIHSS) score at admission, glucose, diastolic blood pressure, uric acid, and low-density lipoprotein, the TyG-Q4 group remained a risk factor for the occurrence of poor functional outcome at discharge in the LAA group (OR = 2.38, 95% CI = 1.03–5.51). However, the TyG index did not correlate with functional outcome at discharge in the CE group. Of note, this negative CE subgroup result should be interpreted cautiously due to the limited sample size and insufficient endpoint events, which may cause inadequate statistical power and false-negative outcomes; thus, the potential predictive value of the TyG index for discharge-level functional outcome in CE stroke cannot be excluded. The TyG index was identified as a risk factor for poor functional outcome at discharge in LAA stroke but was not correlated with the functional outcome at discharge of CE stroke. Considering the limited sample size and insufficient statistical power of the CE subgroup, this negative result should not be over-interpreted, and large-scale clinical studies are required to further explore the potential prognostic value of the TyG index in cardioembolic stroke.