Influences of the neutrophil-hdl ratio, monocyte-hdl ratio and lymphocyte-hdl ratio on patients with acute exacerbation of chronic heart failure

Background: To investigate the role of the neutrophil/high-density lipoprotein cholesterol ratio, monocyte/high-density lipoprotein cholesterol ratio, and lymphocyte/high-density lipoprotein cholesterol ratio in the diagnosis and management of patients experiencing an acute flare-up of chronic heart failure. Methods: The study included 386 individuals who were hospitalised between March 2022 and September 2024 and had acute exacerbations of chronic heart failure. To determine if the research participants had acute renal injury, they were split into two groups: those with kidney injury and those without. Based on whether major adverse cardiovascular events (MACE) happened six months after discharge, the patients were further separated into groups with poor prognoses and those with excellent prognoses. N-terminal B-type brain natriuretic peptide (NT-proBNP), blood lipids, renal function, soluble tumour factor 2 inhibitor (sST2), and routine blood parameters were assessed 24 hours and 3 days following admission. The NHR, MHR, and LHR were calculated, and the glomerular filtration rate (eGFR) was estimated. The left ventricular ejection fraction (LVEF) was measured at 24 hours and 3 days after admission, and the occurrence of major adverse cardiovascular events (MACE) was followed up for 6 months after discharge. Results: The renal injury group's NHR, MHR, LHR, sST2, and NT-proBNP were higher than those of the non-renal injury group and the favourable prognosis group, respectively, 24 hours after admission, whereas the LVEF was lower than that in the non-renal injury group and the good prognosis group (P<0.05). There was no statistically significant difference in BUN, Scr or the eGFR between the two groups (P>0.05). The LVEF and eGFR were significantly lower than those in the non-renal-injury group and the good-prognosis group, respectively. Three days after admission, NHR, MHR, LHR, sST2, NT-proBNP BUN, and Scr were substantially higher in the renal injury and poor prognosis groups (P<0.05). Compared with 24 hours after admission, the BUN and Scr levels of the renal damage and poor-prognosis groups were higher three days after admission, while their eGFR was lower. The statistical significance of the differences was indicated by P<0.05. Individuals with acute exacerbation of chronic heart failure showed positive correlations between NT-proBNP and the NHR, MHR, and LHR (r=0.891, P=0.001; r=0.847, P=0.001; r=0.935, P=0.001). Furthermore, it showed negative correlations with eGFR (r=0.866, P=0.001; r=0.739, P=0.001; r=0.802, P=0.006). Logistic regression analysis revealed that patients with acute exacerbation of chronic heart failure who had elevated NHRs, MHRs, and LHRs 24 hours after admission had an increased risk of concurrent acute kidney injury. The receiver operating characteristic curve analysis revealed that the most substantial predictive value for the incidence of MACEs in patients with acute exacerbation of chronic heart failure was 0.826, corresponding to the area under the curve for the combined detection of NHR, MHR, and LHR. Conclusion: The combined detection of the NHR, MHR and LHR has early predictive value for the prognosis of patients with acute exacerbation of chronic heart failure.