Associations of CHG and TyG indices with early neurological deterioration after intravenous thrombolysis in acute ischaemic stroke and their risk stratification performance

The cholesterol–high-density lipoprotein–glucose (CHG) index and the triglyceride–glucose (TyG) index have been shown in multiple studies to be closely associated with the occurrence and prognosis of acute ischemic stroke (AIS). However, their associations with early neurological deterioration (END) after AIS remain unclear. This study aimed to investigate the associations of the CHG index and TyG index with END in patients with AIS receiving intravenous thrombolysis, and to compare their performance for END risk stratification. We enrolled 352 patients diagnosed with AIS who received intravenous thrombolysis at Hunan Provincial People’s Hospital between September 2019 and October 2025, and calculated CHG and TyG indices for all participants. Statistical analyses were performed using R software. END was defined as an increase in the total National Institutes of Health Stroke Scale (NIHSS) score by ≥ 2 points or an increase in any motor subscore by ≥ 1 point within 7 days after thrombolysis, assessed by standardized trained neurologists. All NIHSS assessments were performed by trained neurologists at baseline (pre-thrombolysis) and 24 h post-thrombolysis. Multivariable logistic regression models adjusted for age, sex, body mass index (BMI), hypertension, diabetes mellitus, smoking history, drinking history, TOAST classification (5 subtypes), and endovascular thrombectomy were used to evaluate the independent associations of the two indices with END risk. Subgroup analyses stratified by age, sex, and body mass index (BMI) were conducted to evaluate the robustness of the results. Restricted cubic spline (RCS) analyses were performed to assess potential nonlinear relationships between the CHG and TyG indices and END. A total of 256 AIS patients were included in the final analysis, of whom 43 experienced END and 213 did not. In the unadjusted model, higher CHG index (per 1 standard deviation increase) was significantly associated with increased END risk (OR = 2.19; 95% CI, 1.37–3.50; P = 0.001), with a larger effect size than the TyG index (OR = 1.51; 95% CI, 1.04–2.19; P = 0.031). After full multivariable adjustment, both indices remained independently and positively associated with END (CHG: OR = 2.17; 95% CI: 1.34–3.52; P = 0.002; TyG: OR = 1.54; 95% CI: 1.02–2.34; P = 0.041). Receiver operating characteristic (ROC) curve analysis indicated that both CHG and TyG indices had moderate risk-stratifying performance for END after thrombolysis in AIS patients, with areas under the curve (AUCs) of 0.747 and 0.724, respectively. The DeLong test did not reveal a significant difference between the AUCs of the CHG and TyG indices ( P = 0.471). Subgroup analyses demonstrated that the directions of the associations between CHG, TyG indices and END were generally consistent across strata of age, sex and BMI. RCS analysis did not detect a significant nonlinear relationship between the CHG/TyG indices and END (CHG: Pnonlinear = 0.292; TyG: Pnonlinear = 0.727). The CHG and TyG indices were independently and positively associated with END after intravenous thrombolysis in AIS patients. The association of the CHG index with END was slightly stronger than that of the TyG index. These metabolic indices may serve as adjunctive metabolic indicators reflecting elevated END risk in AIS patients receiving thrombolytic therapy, although residual confounding from unmeasured clinical and imaging factors cannot be excluded.