Impact of Insulin Resistance and Obesity Indices on Patients Received Recombinant Tissue Plasminogen Activator (r-TPA) in Acute Ischemic Stroke

Background Insulin resistance (IR) and obesity may influence stroke outcomes after recombinant tissue plasminogen activator (r-TPA) therapy. The aim of this work was to analyze the potential impact of IR, body mass index (BMI) and relative fat mass on stroke prognosis in non-diabetic patients after intravenous thrombolytic therapy Methods This Cross-sectional observational study was conducted on 44 patients, with acute ischemic stroke (AIS) received r-TPA. Every single patient underwent routine laboratory examination in addition to serum insulin and assessment of insulin resistance (IR) by the HOMA-IR index (defined as HOMA-IR>2.5). Body mass (BMI), relative fat mass (RFM) indices and computed tomography (CT). Bamford classification was used to categorize the stroke type. National Institutes of Health Stroke Scale (NIHSS) was assessed on admission, after 7 days and after three months. Modified Rankin scale (mRS) was assessed on admission, after 7 days and after 3 months based on which patients were categorized into favorable (0, 1) and unfavorable (2 to 6) outcome. Results Hyperglycemia, serum insulin, HOMA-IR, BMI, and RFM were not significant predictors of NIHSS scores on seven days or at three months. Similarly, these parameters were not significant predictors of mRS scores at three months. The main predictors of unfavorable outcomes in this study were the total anterior cerebral infarction (TACI) type of stroke and symptomatic hemorrhagic transformation. No significant correlation was observed between obesity indices, IR, and initial or follow up NIHSS or mRS scores. Conclusions Although not reaching significance IR showed a trend toward predicting unfavourable outcomes. This borderline finding suggested that IR might have played a role in poststroke recovery, but the strong predictive value of traditional factors (stroke subtype, hemorrhagic transformation) confirms that these should remain the primary focus of acute management and prognostication.