Triglyceride-glucose index as a predictor of one-year mortality in non-diabetic acute ischemic stroke

Background: Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality, and identifying reliable prognostic markers is crucial for improving outcomes. The triglyceride-glucose (TyG) index, a surrogate marker for insulin resistance, has been associated with adverse cardiovascular outcomes. However, its role in predicting stroke prognosis, particularly in non-diabetic patients, remains unclear. This study aimed to explore the association between the TyG index and one-year outcomes, including mortality, recurrence, and adverse functional outcomes, in non-diabetic IS patients. Methods: This prospective cohort study included AIS patients without diabetes from multiple hospitals. Baseline data, including the TyG index, were collected at admission, and patients were followed for one year. The primary outcomes were all-cause mortality, stroke recurrence, and adverse functional outcomes, defined as modified Rankin Scale (mRS) >2. Multivariate logistic regression and subgroup analyses were conducted to assess the predictive value of the TyG index for these outcomes. Results: Among the study population, 5.9% died within one year. The TyG index and its quartiles were significantly associated with one-year mortality, even after adjusting for confounding factors. Patients in the highest TyG quartile (Q4: TyG ≥ 8.9002) had a 3.72-fold higher risk of mortality compared to those in the lowest quartile (P = 0.013). Subgroup analysis showed that the TyG index was a stronger predictor of mortality in men and non-atrial fibrillation patients. Although the TyG index was not significantly associated with stroke recurrence or adverse functional outcomes in the overall cohort, it acted as a protective factor for recurrence in younger patients (< 65 years). Conclusion: The TyG index is an independent predictor of one-year mortality in non-diabetic IS patients and may aid in risk stratification, particularly in men and younger patients. Its potential role in predicting recurrence and functional outcomes warrants further investigation.