Abstract
The application of a simple blood test to predict prognosis in acute heart failure (AHF) patients is not well established. Neutrophil-lymphocyte ratio (NLR) is inexpensive and easy to obtain in hospitalized patients using a routine blood test. We evaluate the prognostic implications of NLR as an independent predictor of in-hospital and long-term mortality in AHF patients. Among 5625 patients enrolled in the Korean Acute Heart Failure registry, 5580 patients were classified into quartiles by their NLR level, and analyzed for in-hospital and post-discharge three-year mortality. Patients in the highest NLR quartile had the highest in-hospital and post-discharge three-year mortality. The same results were seen by dividing the aggravating factor into the infection or ischemia group and the non-infection or non-ischemia group. For patients aggravated from infection or ischemia, a cut-off NLR value was 7.0 that increase the risk of in-hospital and post-discharge three-year mortality. In subgroups of patients not aggravated from infection or ischemia, a cut-off NLR value was 5.0 that increase the risk of in-hospital and post discharge three-year mortality. Elevated NLR in AHF patients at the index hospitalization is an independent predictor for in-hospital and post-discharge three-year mortality. Taken together, NLR is a marker for risk assessment of AHF patients.
Highlights
Inflammation plays a crucial role in the pathogenesis and progression of cardiovascular disease
Neutrophilia is associated with increased incidence of acute decompensated heart failure in patients with acute myocardial infarction [4], and lymphopenia is related to poor prognosis in patients with HF [5,6]
Of the 5625 patients enrolled in the KorAHF registry, 45 patients were excluded because their total and differential White blood cell (WBC) counts were not available (n = 24), or they were not identified whether they survived or died during the follow-up period (n = 21)
Summary
Inflammation plays a crucial role in the pathogenesis and progression of cardiovascular disease. Numerous inflammatory biomarkers are correlated with disease severity and prognosis across throughout heart failure (HF) [1]. White blood cell (WBC) count and its subtypes are classical markers of inflammation in cardiovascular disease [2]. Leukocytosis increases incidence of HF hospitalization and mortality [3]. Neutrophilia is associated with increased incidence of acute decompensated heart failure in patients with acute myocardial infarction [4], and lymphopenia is related to poor prognosis in patients with HF [5,6]. Previous studies showed that NLR is related to increased mortality or heart transplantation risk in patients with chronic HF [10,11], but these studies are limited by single-center study design and relatively small sample size.
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