Acute-to-chronic glycemic ratio is associated with 3-month functional outcome after spontaneous intracerebral hemorrhage: a retrospective cohort study

Spontaneous intracerebral hemorrhage (ICH) is a leading cause of disability and mortality worldwide. Accurate early prognostication is critical for clinical decision-making. Dysglycemia has been implicated in stroke pathophysiology and outcomes, but admission glucose alone may not fully reflect metabolic status. Systemic inflammation plays a key role in post-stroke recovery. This study aimed to investigate the association between the acute-to-chronic glycemic ratio (ACR) and 3-month functional recovery in ICH patients, and to assess whether systemic inflammatory markers modulate this relationship. We conducted a single-center retrospective cohort study of consecutive adult patients with spontaneous ICH admitted within 24 h of symptom onset between January 1, 2021, and September 30, 2023. We retrospectively enrolled 755 patients with spontaneous ICH admitted to the First Affiliated Hospital of Wenzhou Medical University between January 1, 2021 and September 30, 2023. ACR was calculated using admission glucose and glycated hemoglobin (HbA1c). Neutrophil-to-lymphocyte ratio (NLR) and white blood cell count (WBC) were selected as inflammatory markers. The primary outcome was 3-month Barthel Index (BI) score. Multivariable linear and logistic regression were performed to assess the association between ACR and poor functional outcome (BI < 60), respectively, with sequential adjustment for demographic, clinical, inflammatory, and hematoma characteristics. Restricted cubic splines were used to test for non-linear trends. Stratified analyses were conducted to explore the modifying effects of NLR and WBC. ACR was negatively associated with 3-month BI (β = -9.96, p = 0.023). Logistic regression showed that higher ACR was associated with lower 3-month Barthel Index scores and higher odds of poor functional outcome (OR = 5.145, 95% CI: 1.048–25.272, p = 0.044). These associations were reduced after further adjustment for hematoma location and volume and did not reach conventional statistical significance (β = −8.45, 95% CI: −17.21 to 0.33, p = 0.059; OR = 4.527, 95% CI: 0.823–24.892, p = 0.082). Restricted cubic spline analysis indicated a linear relationship between ACR and outcome ( p for non-linearity = 0.195). The association between ACR and outcome was stronger in patients with higher inflammatory burden. Elevated ACR is associated with worse functional recovery after ICH, particularly in the context of heightened systemic inflammation. These observational findings require external validation in prospective cohorts before ACR can be considered as a potential biomarker for clinical risk stratification or treatment selection.