Abstract 9433: The Combination of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as a Novel Predictor of Cardiac Death in Acute Decompensated Heart Failure Patients With Preserved Left Ventricular Ejection Fraction: A Multicenter Study

Abstract

Background: Inflammation plays a central role in the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammatory markers which have been shown to predict post-discharge outcome in patients with HF. However, there is no information available on the combined usefulness of NLR and PLR in patients with HFpEF who are admitted with acute decompensated heart failure (ADHF). Methods: Patients' data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT-HFpEF), which is a prospective multicenter observational registry for ADHF patients with LVEF ≥50% in Osaka area. We studied 1011 patients who survived to discharge. NLR and PLR were measured at the time of admission. The NLR was calculated as the ratio of the neutrophil count to the lymphocyte count, and the PLR was calculated as the ratio of the platelet count to the lymphocyte count. The endpoint was cardiac death (CD). Results: During a follow-up period of 539±423 days, 81 patients had CD. Both NLR and PLR were significantly higher in the patients with than without CD. The optimal cut-off values of NLR and PLR were 4.5 and 193 on receiver operating characteristic curve analysis, respectively. At multivariate Cox analysis, higher NLR (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.49-4.22, p=0.0006) or higher PLR (HR 1.91, 95% CI 1.15-3.19, p=0.0130) were independently associated with CD. Moreover, the combination of higher NLR and higher PNR was the strongest predictor of CD (HR 2.84, 95% CI 1.56-5.17, p=0.0007). There was significant difference in the rate of CD among the three groups stratified by NLR and PLR values. Conclusions: In this multicenter study, the combination of NLR and PLR was shown to be a useful marker for the prediction of post-discharge outcome in patients with HFpEF admitted for ADHF.