The cholesterol, high-density lipoprotein, and glucose index as a metabolic-nutritional biomarker for risk stratification in hospitalized heart failure patients

Background Insulin resistance and dysregulated glucose-lipid metabolism contribute to adverse outcomes in heart failure (HF), yet existing metabolic indicators have limited utility for rapid risk stratification in critically ill patients. The cholesterol, high-density lipoprotein, and glucose (CHG) index may provide a convenient metabolic risk marker in hospitalized HF patients. Methods This study adopted a dual-cohort retrospective design. The training cohort included 1,391 patients from the MIMIC-IV database (2008–2019), and the external validation cohort included 296 patients from an independent hospital-based cohort (July 2023 to December 2025). Patients were stratified into quartiles by CHG index. Kaplan–Meier survival analysis, Cox proportional hazards regression models, and restricted cubic spline (RCS) analysis were performed to assess the relationship between CHG index and in-hospital mortality. Results In the training cohort, in-hospital mortality increased from 8.91% in Q1 to 17.87% in Q4 (log-rank test p = 0.0141). In the fully adjusted model, each 1-unit increase in CHG index was associated with a 76.8% increase in in-hospital mortality risk (HR = 1.768, 95% CI 1.337–2.338; p < 0.001). RCS analysis indicated an approximately linear positive association ( P for overall < 0.001, P for nonlinearity = 0.139). The external validation cohort showed a similar association, with mortality increasing from 4.05% in Q1 to 16.22% in Q4 and a fully adjusted HR of 2.716 (95% CI 1.483–4.962, p = 0.001). Conclusion The CHG index was independently associated with in-hospital mortality in patients with HF, with consistent findings in an external cohort. As an integrative biomarker derived from routine laboratory tests, the CHG index may reflect the interplay between metabolic dysregulation and cardiovascular vulnerability, thereby assisting early risk stratification in hospitalized patients with heart failure.