Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) in prediction of death during acute decompensated heart failure hospitalization
A Baszkowski, K Badura, M Jozwik, M Nadel, A Misiewicz, J DrozdzAbstract
Background
Recent studies have emphasized the role of inflammation in the prognosis of patients with heart failure (HF). While neutrophil-to-lymphocyte radio (NLR), platelet-to-lymphocyte radio (PLR), and systemic immune inflammation index (SII) are predominantly used in oncology, nascent evidence suggests their potential use in HF.
Purpose
We aimed to evaluate the prognostic value of composite inflammatory indices in comparison to clinical and laboratory markers in predicting in-hospital mortality among patients hospitalized due to acute decompensated heart failure (ADHF).
Methods
This was a single-centre retrospective study which enrolled 172 consecutive patients hospitalized due to ADHF between January 2024 and August 2024. We analysed demographic data, medical history, comorbidities, baseline symptoms, electrocardiogram, transthoracic echocardiogram and laboratory test results during hospitalization. Statistically significant factors in prediction of univariable logistic regression model were included in multivariable analysis. Predictive performance of each model was assessed using area under receiver operator characteristic curve (AUROC).
Results
Of 172 total patients hospitalized due to ADHF, 18 died during hospitalization. NLR, SII, and PLR were all independent predictors of in-hospital mortality. NLR, PLR, and SII were associated with increased risk of in-hospital death (odds ratio [OR] 1.26 [95% confidence interval [95% CI]: 1.05-1.52] p=0.01 for NLR, OR 1.007 [95% CI: 1.001-1.014] p=0.03 for PLR, and OR 1.001 [95% CI: 1.001-1.002] p=0.009 for SII). AUROC of NLR, PLR, and SII in prediction of in-hospital death were: 0.778 (95% CI: 0.661-0.896), 0.711 (95% CI: 0.570-0.853), and 0.737 (95% CI: 0.604-0.869), respectively. N-terminal pro-B-type natriuretic peptide (NT-proBNP), which was also an independent predictor of in-hospital mortality, reached AUROC of 0.679 (0.530-0.827). Moreover, NLR, PLR, and SII had higher AUROC when compared to white blood cell count (WBC), neutrophil count (NEU), platelet count (PLT), and C-reactive protein (CRP), whereas lymphocyte count had AUROC of 0.762 (95% CI: 0.649-0.875).
Conclusions
In our cohort inflammatory biomarkers based on complete blood count such as NLR, PLR, and SII were independent predictors of in-hospital mortality among patients hospitalized due to ADHF, demonstrating superior prognostic accuracy over WBC and CRP. Therefore, NLR, PLR, and SII may emerge as accessible, cost-effective tools for predicting adverse clinical outcomes in ADHF patients.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.