Predictive value of triglyceride-glucose index and brain symmetry index for recurrence after acute ischemic stroke_West China Medical Journal

Authors：

LIU Jiajia ,  XIA Hong , XU Yuanyuan

Department of Neurology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P. R. China;

Corresponding author：

XIA Hong, Email: pahan38806@163.com

Keywords：

Acute ischemic stroke; triglyceride–glucose index; brain symmetry index; stroke recurrence; prognostication

DOI：

10.7507/1002-0179.202407223

Video：

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Objective To evaluate the ability of the triglyceride-glucose (TyG) index and the brain symmetry index (BSI) to predict stroke recurrence in patients with acute ischemic stroke (AIS). Methods This retrospective study enrolled 366 AIS patients admitted to the Fourth Affiliated Hospital of Nanjing Medical University between January 2021 and August 2022. Before discharge, resting electroencephalography was recorded to obtain the eyes-open BSI (BSIo) and eyes-closed BSI (BSIc); the TyG index was calculated concurrently. Stroke recurrence was assessed at 3, 6, 12 and 18 months. Logistic regression and receiver-operating characteristic analyses were used to determine the predictive performance of baseline TyG index, BSIo and BSIc. Results Sixty-two patients (16.9%) experienced stroke recurrence within 18 months. Baseline TyG index, BSIo and BSIc were significantly higher in the recurrence group than those in the non-recurrence group (P<0.05). Multivariable logistic regression identified TyG index [odds ratio (OR)=2.273, 95% confidence interval (CI) (1.441, 3.585)] and BSIo [OR=27.305, 95%CI (1.155, 645.737)] as independent predictors of recurrence (P<0.05). TyG index and BSIo provided the highest predictive accuracy for recurrence within 3 months (area under the curve=0.777 and 0.795, respectively); their discriminative ability declined over longer follow-up periods. BSIo correlated positively with the National Institutes of Health Stroke Scale and modified Rankin Scale scores (P<0.001), and was elevated in patients with atrial fibrillation, heart failure or small-artery occlusion (P<0.05), while lowered in patients with diabetes (P<0.05). Conclusion Elevated TyG index and BSIo are closely associated with stroke recurrence after AIS and may serve as useful adjuncts for early risk stratification and individualized secondary prevention.

Citation： LIU Jiajia, XIA Hong, XU Yuanyuan. Predictive value of triglyceride-glucose index and brain symmetry index for recurrence after acute ischemic stroke. West China Medical Journal, 2025, 40(6): 914-919. doi: 10.7507/1002-0179.202407223 Copy

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2.	Lin J, Zuo W, Jin H, et al. Thrombolysis for acute ischaemic stroke: development and update. Brain Commun, 2025, 7(3): fcaf164.
3.	Wang Y, Liu R, Li W, et al. Global magnitude and temporal trends of stroke attributable to lead exposure from 1990 to 2021. Ecotoxicol Environ Saf, 2025, 291: 117865.
4.	Yadegar A, Mohammadi F, Seifouri K, et al. Surrogate markers of insulin resistance and coronary artery disease in type 2 diabetes: U-shaped TyG association and insights from machine learning integration. Lipids Health Dis, 2025, 24(1): 96.
5.	Sharifi-Zahabi E, Nasiri N, Hajizadeh-Sharafabad F, et al. Triglyceride-glucose index and the risk of in-hospital and ICU all-cause mortality: a systematic review and meta-analysis of observational studies. Nutr Diabetes, 2025, 15(1): 8.
6.	Avagimyan A, Pogosova N, Fogacci F, et al. Triglyceride-glucose index (TyG) as a novel biomarker in the era of cardiometabolic medicine. Int J Cardiol, 2025, 418: 132663.
7.	Wang B, Li L, Tang Y, et al. Joint association of triglyceride glucose index (TyG) and body roundness index (BRI) with stroke incidence: a national cohort study. Cardiovasc Diabetol, 2025, 24(1): 164.
8.	Xu M, Zhang P, Liu Y, et al. Quantitative electroencephalography predicts delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a retrospective study. J Clin Neurosci, 2025, 136: 111284.
9.	Yang J, Wu C, Jin Y, et al. Long-term outcomes among ischemic stroke TOAST subtypes: a 12-year Cohort study in China. J Stroke Cerebrovasc Dis, 2024, 33(8): 107783.
10.	Ki MY, Lee HG, Kwon S, et al. Herbal prescription Siryeongtang and acupuncture treatment for gait disturbance due to idiopathic normal pressure hydrocephalus: a case report. Explore (NY), 2025, 21(1): 103097.
11.	Choi J, Kim J, Oh HS. Relationship between insulin resistance surrogate markers with diabetes and dyslipidemia: a Bayesian network analysis of Korean adults. PLoS One, 2025, 20(5): e0323329.
12.	Xu H, Xia Y, Mo R, et al. The association between the triglyceride‒glucose index and short-term mortality in ICU patients with sepsis-associated acute kidney injury. BMC Infect Dis, 2025, 25(1): 257.
13.	Alotaibi A, Mahapatro A, Mirchandani M, et al. Triglyceride-glucose index as a marker in cardiovascular diseases; a bibliometric study and visual analysis. Ann Med Surg (Lond), 2025, 87(3): 1487-1505.
14.	Alhawiti NM, Fouda S, Alotaibi ND, et al. Tailoring dual antiplatelet therapy for stroke prevention: a meta-analysis of timing, duration, regimen, and stroke subtypes. Front Pharmacol, 2025, 16: 1516402.
15.	Wang A, Wang G, Liu Q, et al. Triglyceride-glucose index and the risk of stroke and its subtypes in the general population: an 11-year follow-up. Cardiovasc Diabetol, 2021, 20(1): 46.
16.	Nam KW, Kwon HM, Lee YS. High triglyceride-glucose index is associated with early recurrent ischemic lesion in acute ischemic stroke. Sci Rep, 2021, 11(1): 15335.
17.	Ouyang Q, Xu L, Yu M. Associations of triglyceride glucose-body mass index with short-term mortality in critically ill patients with ischemic stroke. Cardiovasc Diabetol, 2025, 24(1): 91.
18.	Zhang C, Guo K, Xu H, et al. Association between triglyceride-glucose index and the risk of stroke among moyamoya patients: a single-center retrospective study. Front Neurol, 2025, 16: 1547627.
19.	Lansinger J, Swartz MF, Scheffler EJ, et al. Quantitative electroencephalography alpha: delta ratio and suppression ratio monitoring during infant aortic arch reconstruction. Pediatr Neurol, 2025, 163: 96-103.
20.	Agius Anastasi A, Falzon O, Camilleri K, et al. Brain symmetry index in healthy and stroke patients for assessment and prognosis. Stroke Res Treat, 2017, 2017(1): 8276136.
21.	Lanzone J, Motolese F, Ricci L, et al. Quantitative measures of the resting EEG in stroke: a systematic review on clinical correlation and prognostic value. Neurol Sci, 2023, 44(12): 4247-4261.
22.	Chen X, Du X, Lu F, et al. The association between the triglyceride-glucose index, its combination with the body roundness index, and chronic kidney disease in patients with type 2 diabetes in Eastern China: a preliminary study. Nutrients, 2025, 17(3): 492.
23.	Sha Y, Wang Q, Tang M, et al. Long-term prognosis of ischemic stroke in young adults-a single-center chinese cohort study. Brain Behav, 2025, 15(4): e70479.
24.	Wang YP, Jiang Y, Mi L, et al. Developing predictive nomogram models using quantitative electroencephalography for brain function in type a aortic dissection: a prospective observational study. Int J Surg, 2025, 111(3): 2398-2413.
25.	Lima EO, Silva LM, Laurentino RA, et al. Resting-state electroencephalogram microstate and correlations with motor function and balance in chronic stroke. Clin EEG Neurosci, 2025: 15500594251317751.

1. Zhu W, He X, Huang D, et al. Correction to: Global and Regional Burden of Ischemic Stroke Disease from 1990 to 2021: An Age-Period-Cohort Analysis. Transl Stroke Res, 2025.
2. Lin J, Zuo W, Jin H, et al. Thrombolysis for acute ischaemic stroke: development and update. Brain Commun, 2025, 7(3): fcaf164.
3. Wang Y, Liu R, Li W, et al. Global magnitude and temporal trends of stroke attributable to lead exposure from 1990 to 2021. Ecotoxicol Environ Saf, 2025, 291: 117865.
4. Yadegar A, Mohammadi F, Seifouri K, et al. Surrogate markers of insulin resistance and coronary artery disease in type 2 diabetes: U-shaped TyG association and insights from machine learning integration. Lipids Health Dis, 2025, 24(1): 96.
5. Sharifi-Zahabi E, Nasiri N, Hajizadeh-Sharafabad F, et al. Triglyceride-glucose index and the risk of in-hospital and ICU all-cause mortality: a systematic review and meta-analysis of observational studies. Nutr Diabetes, 2025, 15(1): 8.
6. Avagimyan A, Pogosova N, Fogacci F, et al. Triglyceride-glucose index (TyG) as a novel biomarker in the era of cardiometabolic medicine. Int J Cardiol, 2025, 418: 132663.
7. Wang B, Li L, Tang Y, et al. Joint association of triglyceride glucose index (TyG) and body roundness index (BRI) with stroke incidence: a national cohort study. Cardiovasc Diabetol, 2025, 24(1): 164.
8. Xu M, Zhang P, Liu Y, et al. Quantitative electroencephalography predicts delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a retrospective study. J Clin Neurosci, 2025, 136: 111284.
9. Yang J, Wu C, Jin Y, et al. Long-term outcomes among ischemic stroke TOAST subtypes: a 12-year Cohort study in China. J Stroke Cerebrovasc Dis, 2024, 33(8): 107783.
10. Ki MY, Lee HG, Kwon S, et al. Herbal prescription Siryeongtang and acupuncture treatment for gait disturbance due to idiopathic normal pressure hydrocephalus: a case report. Explore (NY), 2025, 21(1): 103097.
11. Choi J, Kim J, Oh HS. Relationship between insulin resistance surrogate markers with diabetes and dyslipidemia: a Bayesian network analysis of Korean adults. PLoS One, 2025, 20(5): e0323329.
12. Xu H, Xia Y, Mo R, et al. The association between the triglyceride‒glucose index and short-term mortality in ICU patients with sepsis-associated acute kidney injury. BMC Infect Dis, 2025, 25(1): 257.
13. Alotaibi A, Mahapatro A, Mirchandani M, et al. Triglyceride-glucose index as a marker in cardiovascular diseases; a bibliometric study and visual analysis. Ann Med Surg (Lond), 2025, 87(3): 1487-1505.
14. Alhawiti NM, Fouda S, Alotaibi ND, et al. Tailoring dual antiplatelet therapy for stroke prevention: a meta-analysis of timing, duration, regimen, and stroke subtypes. Front Pharmacol, 2025, 16: 1516402.
15. Wang A, Wang G, Liu Q, et al. Triglyceride-glucose index and the risk of stroke and its subtypes in the general population: an 11-year follow-up. Cardiovasc Diabetol, 2021, 20(1): 46.
16. Nam KW, Kwon HM, Lee YS. High triglyceride-glucose index is associated with early recurrent ischemic lesion in acute ischemic stroke. Sci Rep, 2021, 11(1): 15335.
17. Ouyang Q, Xu L, Yu M. Associations of triglyceride glucose-body mass index with short-term mortality in critically ill patients with ischemic stroke. Cardiovasc Diabetol, 2025, 24(1): 91.
18. Zhang C, Guo K, Xu H, et al. Association between triglyceride-glucose index and the risk of stroke among moyamoya patients: a single-center retrospective study. Front Neurol, 2025, 16: 1547627.
19. Lansinger J, Swartz MF, Scheffler EJ, et al. Quantitative electroencephalography alpha: delta ratio and suppression ratio monitoring during infant aortic arch reconstruction. Pediatr Neurol, 2025, 163: 96-103.
20. Agius Anastasi A, Falzon O, Camilleri K, et al. Brain symmetry index in healthy and stroke patients for assessment and prognosis. Stroke Res Treat, 2017, 2017(1): 8276136.
21. Lanzone J, Motolese F, Ricci L, et al. Quantitative measures of the resting EEG in stroke: a systematic review on clinical correlation and prognostic value. Neurol Sci, 2023, 44(12): 4247-4261.
22. Chen X, Du X, Lu F, et al. The association between the triglyceride-glucose index, its combination with the body roundness index, and chronic kidney disease in patients with type 2 diabetes in Eastern China: a preliminary study. Nutrients, 2025, 17(3): 492.
23. Sha Y, Wang Q, Tang M, et al. Long-term prognosis of ischemic stroke in young adults-a single-center chinese cohort study. Brain Behav, 2025, 15(4): e70479.
24. Wang YP, Jiang Y, Mi L, et al. Developing predictive nomogram models using quantitative electroencephalography for brain function in type a aortic dissection: a prospective observational study. Int J Surg, 2025, 111(3): 2398-2413.
25. Lima EO, Silva LM, Laurentino RA, et al. Resting-state electroencephalogram microstate and correlations with motor function and balance in chronic stroke. Clin EEG Neurosci, 2025: 15500594251317751.

West China Medical Journal

Predictive value of triglyceride-glucose index and brain symmetry index for recurrence after acute ischemic stroke

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