Markers of malnutrition, inflammation, and tissue remodeling are associated with 1-year outcomes in patients with advanced heart failure.

Abstract

A number of predictive models and biomarkers are used to assess outcomes in patients with advanced heart failure (HF). We sought to evaluate whether markers of malnutrition, inflammation, and tissue remodeling are associated with 1‑year mortality in patients with advanced HF. We analyzed 200 consecutive patients with advanced HF. We assessed markers of inflammation and malnutrition, such as the neutrophil percentage‑to-albumin ratio (NPAR), the advanced lung cancer inflammation index (ALI), and the level of high‑sensitivity C-reactive protein (hsCRP). We also evaluated the level of tenascin‑C (TNC), as well as known markers of HF, such as N‑terminal pro-B-type natriuretic peptide (NT-proBNP), creatinine, and bilirubin. Receiver operating characteristic (ROC) and Kaplan-Meier survival analyses were performed to evaluate the association of each parameter with 1‑year mortality. The median (interquartile range) age of the patients was 58 (51-64) years. The independent predictors of death were ALI (odds ratio [OR], 0.966; 95% CI, 0.941-0.992; P = 0.01) and NPAR (OR, 1.373; 95% CI, 1.126-1.674; P = 0.002), as well as serum levels of TNC (OR, 1.04; 95% CI, 1.020-1.050; P <0.001), hsCRP (OR, 1.187; 95% CI, 1.037-1.360; P = 0.01), NT‑ proBNP (OR, 1.110; 95% CI, 1.100-1.200; P = 0.02), creatinine (OR, 1.034; 95% CI, 1.013-1.055; P = 0.001), and bilirubin (OR, 1.079; 95% CI, 1.014-1.149; P = 0.02). The ROC analysis indicated a good discriminatory power of TNC (area under the curve [AUC] = 0.807), NT‑ proBNP (AUC = 0.760), hsCRP (AUC = 0.706), ALI (AUC = 0.749), and NPAR (AUC = 0.785) in predicting mortality during the 1‑year follow up. Our study demonstrated that a decreased ALI value, increased NPAR value, as well as elevated serum concentrations of TNC, NT‑proBNP, hsCRP, creatinine, and bilirubin are associated with 1‑year mortality in patients with advanced HF.