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

Artikel i vetenskaplig tidskrift
Författare Daniel Åberg
N David Åberg
Katarina Jood
Lukas Holmegaard
Petra Redfors
Christian Blomstrand
Jörgen Isgaard
Christina Jern
Johan Svensson
Publicerad i BMC Neurol
Volym 19
ISSN 1471-2377
Publiceringsår 2019
Publicerad vid Institutionen för neurovetenskap och fysiologi
Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap
Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition
Språk en
Länkar dx.doi.org/10.1186/s12883-019-1406-...
Ämnesord 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
Ämneskategorier Invärtesmedicin

Sammanfattning

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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