A novel nutritional index is associated with adverse outcomes in patients with acute heart failure: insights beyond traditional risk markers

Background Nutritional status is closely associated with clinical outcomes in patients with acute heart failure (AHF). However, the value of simple and comprehensive nutritional indicators in this population remains unclear. This study aimed to investigate the association between the triglyceride–total cholesterol–body weight index (TCBI) and adverse outcomes in patients with AHF. Methods This single-center retrospective cohort study consecutively included patients with AHF admitted between April 2022 and April 2024. TCBI and conventional nutritional indices, including prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and controlling nutritional status (CONUT), were calculated at admission. The primary outcome was a composite endpoint of heart failure rehospitalization or all-cause mortality within 1 year after discharge. Cox regression, restricted cubic spline analysis, threshold effect analysis, ROC analysis, subgroup analyses, and incremental model analyses were performed. Results Among 1,898 patients with AHF, 557 experienced composite events during follow-up. After multivariable adjustment, higher TCBI was independently associated with a lower risk of the composite outcome (HR = 0.70, 95% CI: 0.60–0.81, p < 0.001). TCBI showed the highest discriminatory ability among nutritional indicators (AUC = 0.627). Restricted cubic spline and threshold effect analyses demonstrated a nonlinear association between TCBI and adverse outcomes. After adjustment for traditional cardiovascular risk factors and NT-proBNP, TCBI remained independently associated with outcomes. Compared with the base model including traditional cardiovascular risk factors and NT-proBNP, the addition of TCBI improved model performance, with the C-index increasing from 0.676 to 0.686 and the AUC from 0.703 to 0.716. The association between TCBI and outcomes remained consistent across HFrEF, HFmrEF, and HFpEF phenotypes. Conclusion TCBI was independently associated with heart failure rehospitalization or all-cause mortality in patients with AHF and provided additional prognostic information beyond conventional nutritional indices and NT-proBNP.