Abstract

Background. The mutual relation between heart failure (HF) and inflammation is reflected in blood cell homeostasis. Neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR) were linked to HF severity and prognosis. Aims. Our objective was to compare the three ratios for predicting in-hospital outcome of HF patients, in order to establish which is best suited for clinical practice. Methods. Consecutive HF patients admitted to a Cardiology Department from a tertiary hospital were retrospectively evaluated for inclusion. Readmissions and pathologies modifying the hematological indices were excluded. Extended length of hospital stay (LOS) was considered over 7 d. In-hospital all-cause mortality was evaluated. Results: The hematological indices in heart failure (HI-HF) cohort included 1299 patients with a mean age of 72.35 ± 10.45 years, 51.96% women. 2.85% died during hospitalization. 22.17% had extended LOS. In Cox regression for in-hospital mortality alongside parameters from the OPTIMIZE-HF proposed model, all three ratios were independent predictors of mortality. In Cox regression including NT-proBNP, dyspnea at rest, chronic obstructive pulmonary disease (COPD), age and systolic blood pressure, only MLR was an independent predictor of in-hospital mortality (HR 1.68, 95% CI 1.22 − 2.32, p = .002). In multivariable logistic regression, all three ratios independently predicted extended LOS. MLR > 0.48 associated the highest probability (OR 1.76, 95% CI 1.25 − 2.46, p = .001). Conclusions. Hematological indices could be cost-effective and easily available auxiliary biomarkers for in-hospital prognosis of HF patients. We propose MLR > 0.48 as the strongest predictor of in-hospital mortality and prolonged hospitalization.

摘要

背景。心力衰竭（HF）和炎症之间的相互关系反映在血细胞稳态上。中性粒细胞-淋巴细胞比值（NLR）、单核细胞-淋巴细胞比值（MLR）和血小板-淋巴细胞比值（PLR）与心衰严重程度和预后有关。目标。我们的目标是比较预测 HF 患者住院结果的三个比率，以确定哪个最适合临床实践。方法。对从三级医院心脏病科连续住院的 HF 患者进行回顾性评估以纳入研究。排除再入院和改变血液学指标的病理。延长住院时间 (LOS) 被认为超过 7 天。评估了院内全因死亡率。结果：心力衰竭 (HI-HF) 队列中的血液学指标包括 1299 名患者，平均年龄为 72.35 ± 10.45 岁，51.96% 为女性。2.85% 在住院期间死亡。22.17% 延长了 LOS。在院内死亡率的 Cox 回归以及 OPTIMIZE-HF 提议模型的参数中，所有三个比率都是死亡率的独立预测因子。在包括 NT-proBNP、休息时呼吸困难、慢性阻塞性肺疾病 (COPD)、年龄和收缩压在内的 Cox 回归中，只有 MLR 是院内死亡率的独立预测因子（HR 1.68，95% CI 1.22 - 2.32，p  = .002）。在多变量逻辑回归中，所有三个比率都独立预测了扩展的 LOS。MLR > 0.48 与最高概率相关（OR 1.76，95% CI 1.25 − 2.46，p  = .001）。结论。血液学指标可能是用于 HF 患者院内预后的具有成本效益且易于获得的辅助生物标志物。我们建议 MLR > 0.48 作为院内死亡率和住院时间延长的最强预测因子。