Background: Prognostic heterogeneity is significant in patients with heart failure (HF), and traditional risk assessment remains limited. Chronic inflammation activation and metabolic homeostasis imbalance are considered core pathophysiological processes driving HF progression, but evidence for predicting HF prognosis based on the combined use of conventional inflammatory and metabolic markers is still insufficient. This study aimed to evaluate the association of combined inflammatory and metabolic markers with short-term adverse cardiovascular events in HF patients.

Methods: This was a single-center retrospective cohort study that consecutively enrolled 350 patients with heart failure hospitalized between July 2021 and July 2024. Baseline demographic, clinical history, and laboratory parameters were collected. Neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), systemic immune inflammation index (SII), and triglyceride-glucose index (TyG) were calculated. All patients were followed up for 12 months. The primary endpoint was cardiac death or serious events related to the progression of heart failure. Univariate and multivariate logistic regression analyses were used to screen for independent risk factors, and a combined risk model was constructed. The discriminative ability was evaluated using Receiver Operating Characteristic (ROC) curves.

Results: Multivariate logistic regression analysis showed that smoking history (odds ratio (OR) = 2.96, 95% confidence intervals (95% CI): 1.51–5.79), diabetes history (OR = 4.56, 95% CI: 2.35–8.84), elevated NLR (OR = 1.23, 95% CI: 1.08–1.41), elevated C-reactive protein (CRP) (OR = 1.12, 95% CI: 1.04–1.19), and elevated TyG index (OR = 2.57, 95% CI: 1.43–4.61) were independent risk factors for endpoint events in HF patients. The combined risk model constructed from these five factors showed good discriminative ability, with an area under the ROC curve (AUC) of 0.79 (95% CI: 0.72–0.85).

Conclusions: In patients with heart failure, NLR and CRP, reflecting systemic inflammatory burden, and the TyG index, a marker of insulin resistance/metabolic imbalance, are important independent prognostic factors in addition to traditional risk factors such as smoking and diabetes. An assessment strategy integrating inflammatory and metabolic markers holds promise as a simple and practical clinical tool for risk stratification and individualized management of HF patients.