You Zhou,1– 3 Yingli Xie,2 Jingjing Dong,2 Kunlun He,1,3,* Hebin Che1,3,* 

1School of Medicine, Nankai University, Tianjin, 300071, People’s Republic of China; 2The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, Henan, 471003, People’s Republic of China; 3Medical Innovation Research Department, People’s Liberation Army General Hospital, Beijing, 100853, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Hebin Che, Medical Innovation Research Department, People’s Liberation Army General Hospital, No. 28 Fuxing Road, Beijing, 100853, People’s Republic of China, Email chehebin@301hospital.com.cn Kunlun He, School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin, 300071, People’s Republic of China, Email kunlunhe_301@163.com

Background: Patients with chronic heart failure (CHF) and type 2 diabetes mellitus (DM) are prone to insulin resistance and malnutrition, both of which are significant prognostic factors for CHF. However, the combined effect of the triglyceride–glucose index (TyG index) and prognostic nutritional index (PNI) on the mortality risk in patients with CHF and type 2 DM has not yet been studied.
Methods: We enrolled 3,315 patients with CHF and type 2 DM. We used a multivariate Cox regression model to assess hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk based on TyG index and PNI levels. Furthermore, we constructed a novel index, the insulin resistance–nutritional index (IRNI), defined as TyG index/Ln (PNI), and evaluated its prognostic significance.
Results: During follow-up, 1,214 deaths occurred. Participants with a high TyG index and non-high PNI had a significantly higher mortality risk compared to those with a non-high TyG index and high PNI, with an adjusted HR of 1.91 (95% CI, 1.57– 2.32). The multivariate Cox regression analysis revealed HRs for all-cause and cardiovascular deaths of 1.93 (95% CI, 1.66– 2.26; P < 0.001) and 2.50 (95% CI, 2.05– 3.06; P < 0.001), respectively, when comparing the highest and lowest IRNI tertiles. IRNI’s predictive power was stronger in groups with higher adapted Diabetes Complications Severity Index scores (P for interaction < 0.05). Additionally, adding IRNI to the baseline risk model significantly improved predictive performance, showing a greater effect compared to the TyG index or PNI.
Conclusion: IRNI, a novel and composite index reflecting insulin resistance and nutritional status, emerges as a potentially valuable prognostic marker for patients with CHF and type 2 DM.

Keywords: combined effect, prognostic nutritional index, triglyceride–glucose index, insulin resistance–nutritional index, chronic heart failure and type 2 diabetes