Association of the Naples prognostic score with all-cause and cardiovascular mortality in U.S. patients with heart failure: a retrospective cohort study using NHANES 2001–2018

Background Naples Prognostic Score (NPS) predicts mortality risk in heart failure (HF). Methods and Results This retrospective cohort study utilized data from the 2001–2018 National Health and Nutrition Examination Survey (NHANES), including 1,111 adults with HF. The NPS was calculated based on serum albumin (SA), total cholesterol (TC), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Mortality outcomes were ascertained through linkage with the National Death Index (NDI). Associations between NPS and all-cause mortality (ACM) and cardiovascular mortality (CVM) were evaluated using survey-weighted Cox proportional hazards models and Kaplan-Meier (KM) analyses. Subgroup and sensitivity analyses were performed to assess the robustness of the findings. Over a median follow-up of 70 months (interquartile range [IQR], 36–114 months), 545 ACM and 202 CVM cases were documented. Compared with participants with an NPS of 0, those in the high-risk group (NPS: 3–4) had significantly increased risks of mortality, with adjusted hazard ratios (HRs) of 2.53 (95% confidence interval [CI], 1.38–4.63; P < 0.01) for ACM and 2.62 (95% CI, 1.20–5.74; P < 0.05) for CVM. These associations remained consistent across subgroup and sensitivity analyses, supporting the robustness of the results. Conclusion A higher NPS was independently associated with increased risks of ACM and CVM among U.S. adults with HF. These findings suggest that NPS may serve as a useful prognostic marker; however, further validation in prospective clinical cohorts is warranted.