Atherogenic Lipid Indices and In-Hospital Mortality in Patients with Heart Failure and LVEF <50%: A Retrospective Cohort Study

Abstract

Atherogenic lipid indices may provide complementary prognostic information in heart failure (HF), but their association with short-term mortality remains uncertain. We evaluated the associations of the atherogenic index of plasma (AIP) and total cholesterol-to-high-density lipoprotein cholesterol ratio (TC/HDL-C) with in-hospital mortality among adults hospitalized with HF and left ventricular ejection fraction <50%. This single-center retrospective cohort included 105 patients admitted between January 2023 and December 2025; 24 patients (22.9%) died during hospitalization. AIP was calculated as log10 of the molar triglyceride-to-HDL-C ratio, and TC/HDL-C was calculated from routine lipid measurements. Patients who died had higher AIP than survivors (0.448 ± 0.373 vs 0.270 ± 0.315; P=0.022) and lower HDL-C (21.5 [14.5–34.8] vs 28.0 [21.5–39.5] mg/dL; P=0.039). Each 0.1-unit increase in AIP was associated with higher odds of in-hospital mortality in crude analysis (OR 1.168, 95% CI 1.018–1.340; P=0.026), after multivariable adjustment (aOR 1.165, 95% CI 1.012–1.341; P=0.034), and in Firth penalized sensitivity analysis (aOR 1.151, 95% CI 1.003–1.320; P=0.046). TC/HDL-C was not significantly associated with mortality. Higher AIP was associated with in-hospital mortality and warrants validation in larger prospective multicenter cohorts.