The potential differential significance of admission metabolic markers CHG, TyG and NHHR indices for cerebral artery dissection

Abstract

At present, the diagnosis of cerebral artery dissection (CeAD) worldwide still relies on imaging findings, making rapid clinical differentiation in the early stages challenging. Our purpose is to explore the distribution characteristics of the cholesterol, high-density lipoprotein, and glucose (CHG) index, triglycerides-glucose (TyG) index, and non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) in patients with CeAD at admission through case–control design, so as to evaluate the potential value of the three indicators in the early identification of acute phase and provide guidance for early clinical identification and timely intervention. We collected data on CeAD patients admitted to Tongji Hospital, Wuhan, China, from March 2015 to September 2025, with non-CeAD intracerebral hemorrhage (ICH) patients as the control group. After 1:1 propensity score matching, 128 samples were retained in each group. Logistic regression analysis was used to analyze the correlation between the three indicators and the presence of CeAD. The identification efficacy and dose–response relationship of each indicator were evaluated by receiver operating characteristic (ROC) curve and restricted cubic spline (RCS) curve, and the net benefit of clinical application of each index was evaluated by decision curve analysis (DCA). The results were expressed as odds ratio (OR) and 95% confidence interval (CI). The results showed that compared with non-CeAD ICH, both CHG (OR: 0.310, 95% CI: 0.157, 0.610) and NHHR (OR: 0.757, 95% CI: 0.627, 0.915) showed an independent negative association with the CeAD group, whereas TyG exhibited no significant association with the CeAD group. ROC curve showed that the area under the curve of CHG (0.633) was greater than that of NHHR (0.603) and TyG (0.539), and the optimal cutoff value was 5.342. RCS curve showed that CHG index and NHHR index were linearly correlated with the incidence of CeAD (P < 0.05). The DCA results indicated that, within the core threshold range for acute clinical diagnosis, the CHG index offers positive clinical net benefit and has practical value as an auxiliary tool. Compared with ICH patients, CHG and NHHR showed independent negative associations with CeAD. CHG was relatively better for the auxiliary identification of CeAD and ICH, but the overall identification value of single index was still limited. These findings suggest that CHG and NHHR may reflect distinct acute-phase metabolic characteristics between CeAD and ICH, and provide reference for early clinical auxiliary identification.