The metabolic score for insulin resistance as a predictor of clinical outcome in stroke patients treated by intravenous thrombolysis

Background and purpose Insulin resistance is associated with clinical outcomes among patients with ischemic stroke. We aimed to investigate the association between metabolic score for insulin resistance (METS-IR) and clinical outcomes in stroke patients treated by intravenous thrombolysis (IVT). Methods We recruited participants treated with IVT from a prospective registry including 3 stroke centers. Poor outcome was defined as a modified Rankin scale score ≥ 3 points at 90 days after the index stroke. We performed logistic regression models to investigate the association between METS-IR and the risk of poor outcome. We used the receiver operative characteristic to assess the discriminative ability and the restricted cubic spline to explore the relationship between METS-IR and the poor outcome. Results This study enrolled a total of 1074 patients (median age, 68; 63.8% male). Three hundred sixty (33.5%) patients had poor outcome after IVT. METS-IR was associated with the risk of the poor outcome with the increase of confounding factors in models (odds ratio [ OR ], 1.078; 95% confidence interval [ CI ], 1.058–1.099; P < 0.001). The area under the curve for METS-IR for predicting the poor outcome was 0.790 (95% CI , 0.761–0.819). The restricted cubic spline revealed an increasing and non-linear association between METS-IR and the poor outcome ( P for non-linearity < 0.001). Conclusion Our study found that METS-IR was associated with an increased risk of poor outcome after IVT. Further studies are warranted to investigate the efficacy of anti-diabetic agents regarding IR on clinical outcomes after IVT.