Abstract
BACKGROUND: The triglyceride-glucose (TyG) index, a simple surrogate marker of insulin resistance, has been associated with adverse cardiovascular outcomes. However, data on its prognostic value in elderly patients with acute decompensated heart failure (ADHF) are limited. This study aimed to evaluate the predictive role of the TyG index for one-year all-cause mortality in geriatric ADHF patients. METHODS: This retrospective single-center study included 149 patients aged ≥65 years who were hospitalized with ADHF between January 2023 and December 2024. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Patients were stratified into quartiles based on TyG levels, and outcomes were compared across groups. Receiver operating characteristic (ROC) curves, Kaplan-Meier survival analysis, and multivariate Cox regression were applied to evaluate the prognostic performance of the TyG index. RESULTS: Higher TyG quartiles were significantly associated with increased glucose, triglyceride, and inflammatory marker levels (p < 0.05). ROC analysis demonstrated moderate discriminative ability for one-year mortality (AUC = 0.72, 95% CI: 0.61-0.83, p = 0.001), with an optimal cut-off value of 8.70. Kaplan-Meier curves showed significantly reduced survival in the highest TyG quartile (45.9%) compared with the lowest (89.5%) (log-rank p < 0.001). Although TyG was not an independent predictor in multivariate analysis (HR 1.68; 95% CI: 0.70-4.00; p = 0.25), it was significant in the subgroup with left ventricular ejection fraction <40% (HR 1.91; 95% CI: 1.02-3.59; p = 0.04). Adding the TyG index to a conventional risk model including age, sex, left ventricular ejection fraction, hypertension, chronic obstructive pulmonary disease, cardiovascular disease, and chronic kidney disease significantly improved prognostic accuracy (NRI = 0.273, IDI = 0.011, both p < 0.01). CONCLUSION: Elevated TyG levels are associated with increased one-year mortality and reduced survival in elderly ADHF patients. The TyG index provides incremental prognostic value beyond conventional risk factors and in daily clinical practice may serve as a simple, low-cost tool for risk stratification in geriatric heart failure management.