Previous studies have suggested that the neutrophil-to-lymphocyte ratio (NLR) is a
novel yet readily evaluable inflammatory biomarker that may be useful for determining
cardiovascular prognosis during acute episodes. The study investigated the role of
NLR in predicting cardiovascular (CV) outcomes in patients with acute heart failure
(HF). Individual patient data from the BLAST-AHF (phase 2b study of the biased ligand
of the angiotensin 2 type 1 receptor, TRV027), Pre-RELAX-AHF (phase 2b study of recombinant
human relaxin-2, serelaxin), and RELAX-AHF (phase 3 study of serelaxin) randomized,
placebo-controlled studies for patients with acute HF were pooled for analysis. Dyspnea
visual analog scale area under the curve through day 5, worsening HF through day 5,
30-day all-cause mortality, 60-day HF/renal failure rehospitalizations or CV death,
180-day all-cause mortality, and 180-day CV death were assessed. There were several
differences in the baseline characteristics of the patients divided by NLR tertile,
with patients in the higher NLR having worse clinical characteristics. NLR was an
independent predictor of 30-day all-cause mortality (adjusted hazard ratio [HR] per
log2 NLR increment: 1.66 [1.22 to 2.25], p = 0.001), 60-day HF/renal failure rehospitalizations
or CV death: 1.33 [1.12 to 1.57], p = 0.001), 180-day all-cause mortality (adjusted
HR 1.27 [1.08 to 1.50], p = 0.003), and 180-day CV death (adjusted HR 1.24 [1.04 to
1.49], p = 0.018). NLR, a readily available inflammatory biomarker, was associated
with independent risk for short- and long-term adverse outcomes in acute HF, surpassing
traditional markers, such as natriuretic peptides.
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Article Info
Publication History
Published online: August 03, 2022
Received in revised form:
June 13,
2022
Received:
March 16,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
