Prognostic value of the NAPLES score in patients with dilated cardiomyopathy undergoing ICD implantation
M E Bilgin, S A Balcioglu, M E Gokce, A Donmez, R Turkmen, Z Bulat, S Arslan, M YildizAbstract
Background
Non-ischaemic dilated cardiomyopathy (NIDCM) continues to carry substantial risk of heart failure progression and sudden cardiac death despite contemporary medical therapy. Systemic inflammation and nutritional status have emerged as key contributors to adverse outcomes in this population. Although markers such as the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) have shown variable prognostic value, the Naples Prognostic Score (NAPLES)—a composite index integrating inflammatory and nutritional parameters—has not been evaluated in NIDCM. Determining its prognostic utility may offer a more comprehensive risk-stratification approach than isolated haematological indices or the CALLY score.
Purpose
To investigate the prognostic value of the NAPLES score for predicting all-cause mortality in patients with NIDCM undergoing ICD implantation and to compare its performance with other inflammation-based indices.
Methods
This retrospective, single-centre study included patients with NIDCM who underwent ICD implantation between 2015 and 2025. Baseline clinical, echocardiographic, and laboratory characteristics were extracted from medical records. NAPLES, CALLY, NLR, and LMR were calculated according to established definitions. Patients were followed for all-cause mortality across the study period.
Results
During a mean follow-up of 54.46 ± 24.12 months, 82 patients (34.2%) died. High NAPLES scores were associated with significantly reduced survival (log-rank p<0.001). Patients with high scores were older and demonstrated higher CRP, lower haemoglobin, higher NLR, and lower LMR values (all p<0.001), whereas the CALLY index did not differ significantly. The NAPLES score was significantly higher in deceased patients (p<0.001). ROC analysis showed moderate discriminatory capacity (AUC 0.655, 95% CI 0.584–0.727, p<0.001). In multivariable Cox regression, NAPLES remained an independent predictor of mortality (HR 3.19, 95% CI 1.79–5.69, p<0.001), while CALLY, NLR, and LMR were not independently associated with outcomes.
Conclusions
The NAPLES score independently predicts all-cause mortality in NIDCM patients undergoing ICD implantation and outperforms conventional inflammation-based indices. Incorporating NAPLES into routine assessment may enhance risk stratification and support more targeted follow-up strategies in this high-risk population.tablesfigures