The CHG index is an independent and easily accessible predictor of 90-day functional outcomes in AIS, and by capturing integrated metabolic stress, it may serve as a useful biomarker for early risk stratification.
Key Findings
Results
Among 541 AIS patients, 193 (35.7%) had unfavorable functional outcomes at 90 days, defined as modified Rankin Scale >2.
Retrospective analysis included 541 AIS patients admitted to Shanxi Bethune Hospital between October 2023 and December 2024.
Patients receiving reperfusion therapy or with severe comorbidities were excluded.
Unfavorable functional outcome was defined as modified Rankin Scale (mRS) >2 at 90 days.
193 of 541 patients (35.7%) met the criteria for unfavorable outcomes.
Results
Each one-unit increase in the CHG index corresponded to a 1.7516-fold higher odds of unfavorable functional outcomes.
OR = 1.7516 per one-unit increase in CHG index.
The CHG index was calculated on admission as CHG = ln{[(TC × FBG) / (2 × HDL)] × 18.02}.
The association was statistically significant and independent of other covariates.
This finding supports CHG as an independent predictor of 90-day functional outcomes.
Results
Patients in the highest CHG quartile had 3.1277-fold higher odds of unfavorable outcomes compared to those in the lowest quartile.
Quartile analysis demonstrated a statistically significant trend (p for trend <0.05).
OR = 3.1277 for highest versus lowest CHG quartile.
The progressive increase in risk across quartiles supports a dose-response relationship between CHG and poor outcomes.
Results
Restricted cubic spline analysis supported a linear association between the CHG index and unfavorable functional outcomes.
The linear relationship indicates that risk of unfavorable outcome increases continuously with rising CHG values.
No threshold or non-linear inflection point was identified.
This finding strengthens the interpretation of CHG as a continuous risk marker.
Results
Subgroup analyses revealed consistent associations between CHG index and unfavorable outcomes across multiple patient subgroups.
Consistent associations were found across sex, smoking status, alcohol use, hypertension, and diabetes subgroups.
The consistency across subgroups suggests the CHG index has broad applicability regardless of these clinical characteristics.
No significant interaction effects between CHG and these subgroup variables were reported.
Methods
The CHG index integrates total cholesterol, HDL cholesterol, and fasting blood glucose into a single metabolic marker capturing both lipid and glucose metabolism.
The index is designed to reflect insulin resistance and abnormal lipid profiles simultaneously.
It was measured on admission, making it a clinically accessible early prognostic tool.
The novel index builds on known associations between metabolic disturbances and poor stroke outcomes.
What This Means
This research suggests that a simple calculation combining three routine blood test values — total cholesterol, HDL ('good') cholesterol, and fasting blood sugar — can predict how well stroke patients will recover within 90 days. The formula, called the CHG index, was tested in 541 patients who suffered acute ischemic stroke (the most common type, caused by a blood clot). About one in three patients (35.7%) had poor functional recovery, meaning they needed significant help with daily activities or were severely disabled or deceased at 90 days. Patients with the highest CHG values were more than three times as likely to have poor outcomes compared to those with the lowest values, and the risk increased steadily as the CHG index rose.
This research suggests the CHG index works as a reliable predictor of stroke recovery across a wide variety of patients, including men and women, smokers and non-smokers, and those with or without diabetes or high blood pressure. Because all three components of the CHG index are already measured in standard hospital blood tests, this tool could be applied immediately upon a patient's arrival without requiring any additional testing. The linear relationship found between CHG and poor outcomes means there is no 'safe' threshold — lower values are consistently associated with better recovery.
The practical implication of this research is that healthcare providers may be able to use the CHG index at the time of hospital admission to identify stroke patients at higher metabolic risk who might benefit from closer monitoring or more aggressive management. The index captures 'integrated metabolic stress' — the combined burden of abnormal blood sugar and abnormal cholesterol — which appears to meaningfully worsen stroke recovery beyond what either measure alone might indicate. Further prospective studies would be needed to confirm these findings and determine how the CHG index might be incorporated into clinical decision-making.
Yuan X, Kong X, Zhao M, Li P, Wang H, Jing W. (2026). Association Between the Cholesterol-HDL-Glucose (CHG) Index and 90-Day Functional Outcomes in Patients with Acute Ischemic Stroke.. Brain and behavior. https://doi.org/10.1002/brb3.71505