Association of admission neutrophil-to-lymphocyte ratio and neutrophil-and-monocyte-to-lymphocyte ratio with in-hospital mortality in acute heart failure: A secondary analysis of a cross-sectional study
Lameck Marcel, Faryal M. Raza, Faustini C. Kimondo, Simon C. Peter, Abid M. SadiqBackground
Inflammation contributes to heart failure (HF) progression, and readily available inflammatory biomarkers may provide prognostic information. We evaluated the association and discriminatory performance of admission neutrophil-to-lymphocyte ratio (NLR) and neutrophil-and-monocyte-to-lymphocyte ratio (NMLR) for in-hospital mortality in acute HF.
Methods
This secondary analysis of a cross-sectional study included consecutive patients aged ≥14 years admitted with acute HF to Kilimanjaro Christian Medical Centre, Tanzania, between 1 May and 31 October 2024. Admission NLR and NMLR were calculated from routine hematological parameters and natural log-transformed for logistic regression because of skewed distributions. Univariable and multivariable binary logistic regression assessed associations with in-hospital mortality; variables with p<0.10 in univariable analysis were considered for multivariable inclusion. Receiver operating characteristic (ROC) analysis assessed discrimination and identified study-specific thresholds.
Results
Among 290 patients, 228 (78.6%) were discharged and 62 (21.4%) died. Higher LN(NLR) was associated with mortality in univariable analysis (cOR: 1.47; 95% CI: 1.11–1.96; p=0.008) and remained independently associated after adjustment (aOR: 1.45; 95% CI: 1.04–2.01; p=0.028). Similarly, LN(NMLR) was associated with mortality (cOR: 1.47; 95% CI: 1.10–1.97; p=0.009) and remained independently associated after adjustment (aOR: 1.44; 95% CI: 1.03–2.02; p=0.032). NLR and NMLR demonstrated modest discrimination, with AUCs of 0.625 (95% CI: 0.544–0.705) and 0.624 (95% CI: 0.543–0.705), respectively. Thresholds were 5.35 for NLR and 6.47 for NMLR.
Conclusion
Higher admission NLR and NMLR were independently associated with in-hospital mortality and demonstrated modest discriminatory ability. These inexpensive biomarkers may complement clinical risk stratification, although the thresholds require external validation.