Independent prognostic value of the triglyceride–glucose index and its incremental predictive contribution beyond traditional risk markers in acute heart failure: a retrospective cohort study

Background: Risk stratification in patients hospitalized with acute heart failure remains challenging. Although N-terminal pro-B-type natriuretic peptide (NT-proBNP) is widely used for prognostic assessment, its predictive performance varies across clinical contexts. The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, has been associated with adverse cardiovascular outcomes, but its prognostic relevance in acute heart failure is not well established. Methods: This single-center retrospective cohort study included 712 patients hospitalized with acute heart failure. TyG was calculated using fasting triglyceride and glucose levels at admission. The primary endpoint was a composite outcome of cardiovascular death or rehospitalization for heart failure. Cox proportional hazards models, restricted cubic spline analysis, threshold effect analysis, and receiver operating characteristic (ROC) curve analyses were performed. When analyzed by quartiles, patients in the highest TyG quartile had a significantly higher risk compared with those in the lowest quartile (HR = 2.17, 95% CI: 1.34-3.50). Restricted cubic spline analysis demonstrated a significant nonlinear association, with a threshold identified at TyG = 9.659. ROC analyses showed that TyG had a discriminative ability comparable to NT-proBNP, while the combined model achieved a higher area under the curve than either marker alone. Conclusions: TyG is independently associated with adverse composite outcomes in patients.