Hemoglobin/creatinine ratio predicts mortality in hospitalized patients for acute heart failure with reduced ejection fraction

Abstract Introduction Heart failure (HF) remains one of the major global healthcare challenges, accounting for 10% of hospital admissions among patients over 65 years old and exhibiting an approximately 50% five-year mortality rate (1). It is crucial to identify new predictive parameters for patient outcomes in order to precisely determine follow-up intervals and guide therapeutic decisions. Recently, the hemoglobin/creatinine (Hb/Cr) ratio has been shown to predict adverse outcomes in patients with cardiovascular disease, particularly in the setting of acute coronary syndromes (ACS) (2). However, limited evidence exists regarding its ability to predict long-term mortality in patients hospitalized for acute heart failure (AHF). Purpose To evaluate the long-term prognostic impact of the Hb/Cr ratio in hospitalized patients for AHF. Methods A retrospective observational study was conducted on patients admitted to the intensive care unit of our hospital for AHF with reduced ejection fraction (EF 40%) from January 2017 to December 2024. Patients were followed until February 2025, and mortality events were recorded. Results The study included 303 patients with a mean age of 69.8 ± 11.8 years, 79.2% of whom were male, and a mean EF of 29.3 ± 8.9%. 69 patients (22.7%) died after discharge. A bivariate Pearson correlation analysis revealed a significant inverse relationship between the Hb/Cr ratio and post-discharge mortality (r = -0.199, p 0.001). Cox regression analysis confirmed that the Hb/Cr ratio independently predicted post-discharge mortality even after adjusting for age, sex, BNP at admission, EF, hypertension, smoking, dyslipidemia, and diabetes mellitus (HR: 0.903, 95% CI: 0.839–0.972, p=0.006). Additionally, ROC curve analysis demonstrated that the Hb/Cr ratio had acceptable discriminative ability (AUC: 0.744, 95% CI: 0.670–0.870, p 0.001). Next, the population was divided into quartiles based on the Hb/Cr ratio. The first quartile comprised patients with a ratio below 8.54, and the third quartile included those with a ratio above 15.65. Kaplan–Meier curves were generated comparing patients in the first and third quartiles. Log-rank analysis revealed that patients in the first quartile had significantly lower survival (χ² = 32.9, p 0.001), whereas those in the third quartile had significantly higher survival (χ² = 9.65, p 0.002). In addition to this the creatinine value at admission did not independently predict mortality in the same Cox regression model used for the Hb/Cr ratio (HR: 1.101, 95% CI: 0.947–1.281, p=0.201). In contrast, the hemoglobin value at admission was significantly associated with out-of-hospital mortality in the same model (HR: 0.815, 95% CI: 0.696–0.955, p=0.012). However, the AUC was less significant compared to the Hb/Cr ratio (AUC: 0.725, 95% CI: 0.651–0.799, p=0.038). Conclusion The Hb/Cr ratio may serve as a valuable prognostic marker for long-term mortality in patients hospitalized for AHF with reduced EF.