Association between triglyceride–glucose index, perihematomal edema, and functional outcome after intracerebral hemorrhage

Background The triglyceride-glucose (TyG) index is a composite measure derived from fasting triglyceride and glucose concentrations. Although it is often used as a surrogate of insulin resistance in stable populations, values obtained during acute intracerebral hemorrhage (ICH) may also reflect the acute metabolic stress response. Its associations with perihematomal edema (PHE) and functional outcome after ICH remain uncertain.Methods This retrospective study included 155 patients with spontaneous ICH admitted within 72 hours of symptom onset. Hematoma and PHE volumes were measured on baseline non-contrast computed tomography (CT), and relative PHE was calculated as PHE volume divided by hematoma volume. The TyG index was calculated from fasting triglyceride and glucose measurements obtained within 24 hours of admission. The interval from symptom onset to baseline imaging was recorded in hours. Primary multivariable models adjusted for age, sex, baseline National Institutes of Health Stroke Scale (NIHSS), baseline Glasgow Coma Scale (GCS), hematoma volume, and onset-to-imaging time; expanded sensitivity models additionally adjusted for hypertension and diabetes.Results Median onset-to-imaging time was 7.0 hours (interquartile range [IQR], 4.0–15.5), and 134 of 155 patients (86.5%) underwent baseline imaging within 24 hours. In the expanded adjusted analyses, higher TyG remained associated with greater relative PHE (β = 0.184, 95% CI 0.094–0.274; P < 0.001) and poor 3-month outcome (adjusted OR = 4.10, 95% CI 1.75–9.60; P = 0.001). Greater relative PHE was also associated with poor outcome (adjusted OR = 5.21, 95% CI 1.07–25.27; P = 0.041). Results were consistent in the sensitivity analysis restricted to patients imaged within 24 hours.Conclusions Higher acute-phase TyG index was associated with greater relative PHE and worse 3-month functional outcome after spontaneous ICH even after accounting for onset-to-imaging time and available clinical confounders. These findings remain observational and require prospective confirmation.