Can the triglyceride-glucose index predict stroke outcomes? A systematic review and meta-analysis

Objective: To assess the link between the triglyceride-glucose (TyG) index and stroke-related outcomes. Methodology: PubMed, Embase and Scopus databases were searched between January 1, 2000 to November 15, 2024 for studies reporting association between TyG and stroke outcomes. Pooled effect sizes were calculated as relative risks (RR) with 95% confidence intervals (CI). Results: Twenty five studies were included. High TyG levels significantly correlated with increased mortality during hospital stay (RR 1.70, 95% CI: 1.15 to 2.52), at three months (RR 1.96, 95% CI: 1.12 to 3.45) and at 12 months (RR 1.43, 95% CI: 1.07 to 1.91) follow-ups. Similarly, high TyG levels were linked to higher recurrence risk at three months (RR 2.75, 95% CI: 1.31 to 5.78) and 12 months (RR 1.41, 95% CI: 1.18 to 1.68) post-stroke. Elevated TyG was also linked to an increased risk of early neurological deterioration (END) during hospital stay (RR 3.28, 95% CI: 1.71 to 6.30) and poor functional outcome at three months (RR 1.67, 95% CI: 1.18 to 2.37) follow-up. Subgroup analyses showed consistent results across study designs, geographic locations and sample sizes. Low to very low certainty of evidence across various outcomes was detected by GRADE. Conclusions: Elevated TyG index might be a significant predictor of mortality, recurrence, END and poor functional outcomes in stroke patients, emphasizing its potential as a prognostic biomarker. Further studies are needed to explore its utility in clinical decision-making.