Neutrophil-lymphocyte ratio (NLR) as an independent factor of 1-year mortality in patients with chronic heart failure with reduced ejection fraction

Inflammatory components play a prominent role in the pathogenesis of heart failure (HF) and correlate with the progression and severity of the disease. The aim of the present study was to assess the association between the neutrophil-lymphocyte ratio (NLR) and mortality risk in patients with stable HF with reduced ejection fraction (HFrEF). A total of 140 patients hospitalized due to a scheduled routine examination without HF exacerbations were included. NLR was calculated as follows: NLR = neutrophil level [G/L]/lymphocyte level [G/L]. The average age in the study sample was 54.1 ± 11.3 years. NLR was significantly associated with co-existing atrial fibrillation and parameters related to nutrition: total cholesterol, triglycerides, low-density lipoproteins, and albumin. During a median follow-up (365 days; IQR 296.5-365), 17 (12.1%) patients died. The log-rank test showed the worst survival rate in the highest NLR tertile. A higher NLR value was an independent predictor of 1-year mortality (HR 1.326, 95% CI: 1.121-1.569, p = 0.0010) after adjustment for natriuretic peptides, comorbidities, and other clinical parameters. It retained its value even after the exclusion of patients with severe kidney dysfunction (eGFR < 30mL/min/1.73m²) and with chronic obstructive pulmonary disease (COPD). Neutrophil-lymphocyte ratio could be deployed as an auxiliary, no-cost marker of worse 1-year prognosis in stable HFrEF patients.