The role of blood lipid and triglyceride‑glucose index in intracranial aneurysms: A retrospective study

Abstract

Objective

The association between blood lipids and aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain, with current research yielding conflicting results. Limited studies have explored the link between the triglyceride-glucose (TyG) index and the prognosis of subarachnoid hemorrhage. In this retrospective study, we investigated the connection between blood lipids and aSAH, along with the correlation between the TyG index and the prognosis of aSAH.

Method

This study included 558 patients with IAs who were separated into two groups based on whether their aneurysms had ruptured or not. Moreover, according to the modified Rankin Scores (mRS), aSAH patients were categorized into the favorable prognosis group (mRS < 3) and the poor prognosis group (mRS > 3).The clinical data of gender, age, accompanied chronic diseases (hypertension, diabetes), cigarette history, alcohol history, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood glucose (BG), mRS of aSAH patients, and responsible aneurysm features were also recorded. The TyG index is calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The t-test, Mann-Whitney U test, or one-way analysis of variance are used to compare differences in continuous variables, whilst the chi-square test or Fisher’s exact test is used to evaluate differences in categorical variables. Blood lipid levels were evaluated using multivariable logistic regression and receiver operating characteristic (ROC) analysis to examine their potential to predict IA rupture. Spearman correlation analysis was used to analyze the relationships between the TyG index and the mRS.

Result

This study enrolled in 558 consecutive patients with 299 unruptured and 259 ruptured IAs patients. The results of the univariate analysis indicated that age, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) levels were higher in patients with ruptured IAs, while triglyceride (TG) levels were lower in ruptured group (P < 0.05). Female aSAH patients had higher levels of TC and LDL-C (P < 0.05). Different from female patients, the HDL-C levels in male ruptured patients was higher than unruptured (P < 0.05). Multivariate logistic regression model analysis showed that high levels of TC (OR = 0.382, 95 %Cl: 0.219 – 0.665) and LDL-C (OR = 5.028, 95 %Cl: 2.606 – 9.703) increased the risk of aSAH in female patients. High levels of HDL-C (OR = 3.964, 95 %Cl: 1.493– 10.525) increased the risk of aSAH in male patients. In aSAH patients, multivariable logistic regression showed that the TyG index was associated with the prognosis of aSAH. Correlation analysis showed that the TyG index was positively correlated with mRS (rs = 0.44, P < 0.001).

Conclusion

This study demonstrated that elevated levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are associated with an increased risk of intracranial aneurysm (IA) rupture in female patients. Conversely, high levels of high-density lipoprotein cholesterol (HDL-C) are a risk factor for IA rupture in male patients. Additionally, the Triglyceride-glucose (TyG) index showed a positive correlation with the modified Rankin Scale (mRS), suggesting its potential utility in evaluating the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH).