Abstract 10010: Long-Term Prognostic Value of the Combination of Ahead Score and a Systemic Inflammation-Nutrition Index in Patients Admitted for Acute Decompensated Heart Failure

Abstract

Backgrounds: Comorbidities are strongly associated with poor clinical outcome in heart failure patients (pts). AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes in acute decompensated heart failure (ADHF) pts. On the other hand, systemic inflammation plays a critical role in the outcomes of heart failure and malnutrition is also associated with poor outcome in heart failure pts. It has been recently reported that advanced lung cancer inflammation index (ALI), which is calculated as body mass index х serum albumin / neutrophil to lymphocyte ratio (NLR), is an independent prognostic marker in several types of cancer. We sought to investigate the prognostic value of the combination of AHEAD score and ALI in pts admitted for ADHF. Methods and Results: We studied 260 pts admitted for ADHF and discharged with survival. At the discharge, we evaluated AHEAD score (range 0-5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus) and measured ALI. The study endpoint was cardiovascular-renal poor outcome (CVR), defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. During a follow-up period of 5.1±4.2 years, 77 pts had CVR. At multivariate Cox analysis, AHEAD score and ALI were significantly associated with CVR, independently of prior heart failure hospitalization, systolic blood pressure and serum sodium level. Pts with both high AHEAD score (≥3 determined by ROC analysis: AUC 0.651[0.582-0.719]) and low ALI (<35.8: AUC 0.7171[0.648-0.786]) had a higher risk of mortality than those with either and none of them (59% vs 28% vs 15%, p<0.0001, respectively). Conclusion: The combination of AHEAD score and ALI would be useful for stratifying patients at risk for cardiovascular-renal poor outcome in ADHF pts.