Neutrophil Lymphocyte Platelet Ratio (NLPR) As A Novel Marker For Predicting Mortality In Patients With Heart Failure With Preserved Ejection Fraction

Abstract Introduction Heart failure with preserved ejection fraction (HFpEF) now accounts for nearly half of heart‑failure admissions and carries a grim prognosis, yet clinicians lack quick, low‑cost tools for early risk stratification. Emerging evidence implicates systemic, low‑grade inflammation—captured by blood‑cell ratios—in HFpEF pathobiology. Method We performed a retrospective cohort study using the publicly available MIMIC-IV database. Adults (≥18 y) with HFpEF were identified by ICD-9/10 codes and a documented left-ventricular ejection fraction ≥ 50%. NLPR was calculated as (neutrophils ÷ lymphocytes) × platelets. The primary endpoint was 28-day all-cause mortality. Univariate and multivariable logistic regression and Kaplan-Meier survival curves assessed the association between NLPR and mortality. Result Among 871 eligible patients (median age 74 y; 55% men), 43 (4.9 %) died within 28 days. Median NLPR was markedly higher in non-survivors than survivors (6.06 vs 2.15). An NLPR cut-off of 5.0 optimally discriminated risk (sensitivity 82.2 %, specificity 62.9 %; AUC 0.73). Each one-unit rise in NLPR independently increased 28-day mortality odds by 4 % (adjusted OR 1.04, 95 % CI 1.01–1.08; p = 0.031). Patients with NLPR ≥ 5.0 had significantly lower 28-day survival (log-rank p < 0.0001). NLPR retained predictive value for 90-, 180- and 365-day mortality, though discrimination declined over time. Conclusion Elevated NLPR is an independent, readily available predictor of short-term mortality in HFpEF. Incorporating NLPR into routine assessment could improve early risk stratification and guide intensified monitoring or anti-inflammatory therapies. Prospective, multicentre validation is warranted.