Abstract: TH-PO471

Insulin Resistance Index from OGTT Predicts Outcomes of Ischemic Stroke in Non-Diabetic Patients with Renal Dysfunction

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Zhou, Yi-Lun, Beijing Tiantan hospital, Capital Medical University, Beijing, China
  • Zhang, Yin, Beijing Tiantan hospital, Capital Medical University, Beijing, China
  • Pan, Yuesong, Beijing Tiantan hospital, Capital Medical University, Beijing, China
  • Wang, Yilong, Beijing Tiantan hospital, Capital Medical University, Beijing, China
  • Wang, Yongjun, Beijing Tiantan hospital, Capital Medical University, Beijing, China

Group or Team Name

  • On behalf of ACROSS-China group
Background

Insulin resistance is associated with increased stroke risk and poor stroke outcomes. Renal dysfunction contributes substantially to both insulin resistance and adverse outcomes of ischemic stroke. However, the impact of impaired renal function on the associations of insulin resistance with stroke outcomes is unknown. Therefore, we sought to investigate the associations of both fasting and post-glucose load insulin resistance indices with ischemic stroke prognosis in non-diabetic patients with impaired renal function.

Methods

Patients with ischemic stroke without a history of diabetes mellitus in the Abnormal Glucose Regulation in Patients with Acute Stroke across China (ACROSS-China) registry were included. Fasting and oral glucose tolerance test (OGTT) derived measures of insulin resistance,the homeostatic model assessment of insulin resistance (HOMA-IR) and the insulin sensitivity index (ISI) were calculated. The highest quartile of HOMA-IR (Q4) or the lowest quartile of ISI (Q1) in the overall population was defined as insulin resistance. The associations between insulin resistance and stroke outcomes were investigated according to estimated glomerular filtration rate (eGFR) strata.

Results

Among 1196 patients, HOMA-IR Q4 vs.Q1-3 was associated with increased 1-year mortality (adjusted hazard ratio [95% confidence interval], 1.75 [1.03-3.00]) and poor outcome (adjusted odds ratio 2.23 [1.43-3.46]) only in participants with eGFR≥90ml/min/1.73m2. In comparison, ISI Q1 vs. Q2-4 was associated with higher risks of mortality (adjusted hazard ratios: 3.69 [0.95-14.40]; 2.21 [1.02-4.78]; and 1.81 [1.05-3.11]) and poor outcome (adjusted odds ratios: 3.96 [1.02-15.28]; 1.96 [1.00-3.82]; and 2.25 [1.42-3.57]) in all three subgroups with eGFR<60, 60-89, and ≥90 ml/min/1.73m2, respectively.

Conclusion

OGTT derived estimate of insulin resistance with ISI was associated with increased risks of 1-year mortality and poor outcome in non-diabetic ischemic stroke patients with impaired renal function. While the predictive value of HOMA-IR was compromised in the context of renal dysfunction.

Funding

  • Government Support - Non-U.S.