Higher Insulin Resistance Level is Associated with Worse Clinical Response in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Insulin resistance is linked to atherosclerotic cardiovascular diseases and stroke. We investigated whether there is a relationship between insulin resistance and clinical findings and outcomes of acute ischemic stroke patients treated with intravenous thrombolysis. In our study, 180 acute ischemic stroke non-diabetic patients treated with intravenous recombinant tissue-type plasminogen activator (iv rt-PA) were evaluated for insulin resistance assessed by homeostasis model assessment insulin resistance (HOMA-IR). The threshold for HOMA-IR was determined as 2.7. Patients were grouped as HOMA-IR>2.7 and HOMA-IR <= 2.7. Clinical features at baseline, 24th hour, and 3rd month were examined. Computed tomography (CT) findings for hemorrhagic transformation were also assessed. Patients with HOMA-IR>2.7 had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores at 24th hour (p=0.005) and higher modified Rankin Scale (mRS) scores at 3rd month (p=0.011). Logistic regression analysis displayed that the presence of HOMAIR>2.7 increases the likelihood of poor outcome 2.93 times (confidence interval [CI] 1.001-1.079) (p=0.003). There was no statistically significant difference between baseline clinical features, hemorrhagic transformation (p=1.000), and mortality (p=0.350) rates. Insulin resistance at higher levels seems to be associated with poor clinical courses and outcomes in patients who received iv rt-PA.