Predictors of mortality in heart failure patients with reduced ejection fraction: neutrophil-to-lymphocyte ratio, platelets-to-lymphocyte ratio, neutrophil- percentage-to-albumin-ratio

Heart failure (HF) is one of the most common causes of hospitalization worldwide. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), NPAR (neutrophil-percentage-to-albumin-ratio) are markers of body inflammatory response that have been associated with worse outcomes in HF patients.

Primary aim of this study was to investigate predictive value of admission NLR, PLR and NPAR in decompensated heart failure patients with reduced ejection fraction (HFrEF) for 30-days cardiovascular mortality and heart failure rehospitalization.

The study enrolled 137 patients consecutively admitted with HFrEF at Cardiology Department of our Clinical Hospital between January 2023 and December 2023. The admission NLR, PLR and NPAR were obtained from the electronic health system and correlated with comorbidities, echocardiographic, and laboratory parameters, and 30-days cardiovascular rehospitalization and mortality. Exclusion criteria: age < 18 years old, pregnancy, active malignancy, platelet count <100 x 109/L, decompensated cirrhosis, and sepsis. Multivariable Cox regression model with time-varying coefficients was used to examine changes in the association between admission NLR, PLR and NPAR and cardiovascular rehospitalization and mortality 30 days after discharge, and Pearson correlation test to predict the relationship between length of stay (LOS), NT-proBNP and presence of iron deficiency anemia with admission values of NLR, PLR and NPAR.

Study included 95 men and 42 women (median age: 69 years; range: 35–89 years). The median values of NLR, PLR, and NPAR were as follows: 4 (1.0–29.0), 173.0 (25.0–987.0), 1.9 (0.9–3.2), 15.1 (12.3-30.1). After 30 days of follow-up, 22 patients (16.05%) died and 12(8.7%) were rehospitalized. In Cox regression models with adjustment for sex, NYHA class, and left ventricular end-diastolic diameter (mm), higher values of NLR, PLR and NPAR were independently associated with cardiovascular mortality and rehospitalization in all NYHA classes (p<0001) (Table 1). The most significant results were recorded for NLR and NPAR. The NLR and the NPAR value were higher in the following group of patients with NYHA III–IV (median: 6.0 vs. 2.0; p < 0.001; median: 4.7 vs. 2.2; p < 0.001). There was a negative correlation between LOS in the hospital, increased levels of NT-proBNP and present iron deficiency anemia and admission value of NLR (r=-0.1, -0.3, -0.5, P<0.05).

NLR and NPAR are independent predictors of 30-days mortality in HFrEF patients. Only NLR value correlated with LOS in the hospital, increased levels of NT-proBNP and present iron deficiency anemia. This finding demonstrates the value of inflammatory markers in predicting prognosis of HFrEF patients, but more prospective studies need to be done which will include more patients and parameters.