Association Between the Cholesterol–HDL–Glucose (CHG) Index and 90‐Day Functional Outcomes in Patients with Acute Ischemic Stroke

BACKGROUND: Acute ischemic stroke (AIS) is a major cause of global disability and mortality. Metabolic disturbances, such as insulin resistance (IR) and abnormal lipid profiles, are linked to poor outcomes. The novel cholesterol, high-density lipoprotein (HDL), and glucose (CHG) index integrates glucose and lipid metabolism, but its prognostic significance in AIS remains unclear. METHODS: This retrospective analysis included 541 AIS patients admitted to Shanxi Bethune Hospital between October 2023 and December 2024, excluding those receiving reperfusion therapy or with severe comorbidities. The CHG index was calculated on admission as CHG = ln{[(TC × FBG) / (2 × HDL)]× 18.02}. Unfavorable functional outcome at 90 days was defined as modified Rankin Scale >2. RESULTS: Among 541 patients, 193 (35.7%) had unfavorable outcomes. Elevated CHG levels were significantly associated with a progressively higher risk of unfavorable outcomes. Each one-unit increase in CHG corresponded to 1.7516-fold higher odds of unfavorable outcomes (OR = 1.7516). Quartile analysis showed that patients in the highest CHG quartile had 3.1277-fold higher odds of unfavorable outcomes compared to the lowest quartile (p for trend <0.05). Restricted cubic spline analysis supported a linear association between CHG and unfavorable outcomes. Subgroup analyses revealed consistent associations across sex, smoking, alcohol use, hypertension, and diabetes. CONCLUSION: The CHG index is an independent and easily accessible predictor of 90-day functional outcomes in AIS. By capturing integrated metabolic stress, it may serve as a useful biomarker for early risk stratification.