Triglyceride glucose index as a biomarker to differentiate stroke subtypes: A hospital-based cross-sectional study

Background: A growing body of literature suggests that the triglyceride-glucose (TyG) index is linked to ischemic stroke in several ways. The usefulness of this biomarker to differentiate etiologic stroke subtypes has not been thoroughly studied. We aimed to figure out whether the TyG index differentiates cardioembolic (CE) from non-cardioembolic (NCE) strokes. Methods A cross-sectional hospital-based study of consecutive stroke cases admitted to the University Hospital of Monastir in Tunisia from January 2018 to December 2022. The TyG index was calculated through the natural logarithm (Ln) of the product of triglyceride and glucose fasting levels. A binary logistic regression was performed to analyze the association between the TyG index and the studied stroke subtypes. We plotted the receiver operating characteristic curve (ROC curve) to determine the best cutoff point for the TyG index in differentiating between CE and NCE stroke subtypes. Results: We included 320 patients (mean age: 64.2 {+/-}11.1 years; 65.3% males). The TyG index values were independently associated with the NCE subtype (OR=2.38; 95% CI=1.52-3.73; p<0.001) when analyzed as a continuous data variable. Logistic regression of quartile distribution showed that the probability of developing a NCE stroke increased proportionally with the TyG index quartiles. The ROC curve showed an area under the curve of 0.636 (95% CI=0.565-0.707; p<0.001) with a cutoff of 8.8 (sensitivity = 68.8%, specificity = 57%). Conclusion: High levels of the TyG index are associated with a higher prevalence of NCE stroke while low values are associated with CE strokes. Thus, the TyG index can be a useful biomarker in the differentiation between CE and NCE stroke subtypes.