Insulin resistance is an independent risk factor for early neurological deterioration in non-diabetic patients with acute ischemic stroke

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The role of insulin resistance (IR) in stroke prognosis remains largely unknown. This study aimed to investigate the relationship between IR and the risk of early neurological deterioration (END) in non-diabetic patients with acute ischemic stroke.


This is a retrospective analysis of non-diabetic patients with acute ischemic stroke enrolled in the prospective multicenter ACROSS-China study. The homeostasis model assessment 2 (HOMA2-IR) was evaluated and the patients were divided into HOMA2-IR quartiles (Q1 0–1.24, Q2 1.25–1.95, Q3 1.96–2.96, Q4 ≥ 2.97). END was defined as an increment in total National Institutes of Health Stroke Scale (NIHSS) of ≥ 2 points or ≥ 4 points on day 14 ± 3 after stroke onset. Logistic regression was performed to explore the relationship between HOMA2-IR and END.


Finally, 556 patients were included (63.7 ± 12.9 years, 64.6% male); thirty-three patients developed END. The median HOMA2-IR of all patients was 1.95 (inter-quartile = 1.24–2.96). There were 148, 135, 130, and 143 patients in Q1, Q2, Q3, and Q4, respectively. Compared with Q1, END (NIHSS ≥ 2) risk was increased in Q4: adjusted odds ratio (OR) = 6.051, 95% CI = 1.638–22.354, P = 0.0069. In additon, END (NIHSS ≥ 2) risk was increased in Q4 compared with the Q1–Q3 combined group: adjusted OR = 2.853, 95% CI = 1.308–6.224, P = 0.0084. END (NIHSS ≥ 4) risk was also increased in Q4: adjusted OR = 7.507, 95% CI = 2.357–23.906, P = 0.0006) compared with the Q1–Q3 combined group.


This study strongly suggests that IR is probably an independent risk factor for END in non-diabetic patients with acute ischemic stroke.

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The data sets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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This study was supported by the National Natural Science Foundation of China (81601015) and Beijing Talents Fund (2015000021469G220).

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Correspondence to Liping Liu.

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Mi, D., Wang, Y., Wang, Y. et al. Insulin resistance is an independent risk factor for early neurological deterioration in non-diabetic patients with acute ischemic stroke. Neurol Sci (2020).

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  • Stroke
  • Insulin resistance
  • Early neurological deterioration