Serum hemoglobin-to-creatinine ratio is associated with early surrogate markers of anthracycline-related cardiotoxicity: a retrospective analysis

The quest for new, reliable prognostic markers of cardiovascular toxicity in patients undergoing anthracycline therapy remains a crucial challenge. The serum hemoglobin-to-creatinine ratio (Hb/Cr) has never been investigated in this setting. We explored the association between the Hb/Cr ratio and early surrogate markers of anthracycline-related cardiotoxicity in patients with hematological disorders. Among 171 patients included in a retrospective registry, 7 were excluded due to missing data. Patients underwent echocardiographic evaluation before and after at least one cycle of anthracycline-based chemotherapy, over a median follow-up of 135 days. The primary endpoint was post-chemotherapy cardiac dysfunction (PCCD), defined as a composite of reduced left ventricular ejection fraction, new-onset diastolic dysfunction, or increased left ventricular end-diastolic diameter. Patients were stratified into low versus high Hb/Cr groups. After at least one chemotherapy cycle, PCCD occurred more frequently in patients with lower Hb/Cr values (57.5% vs. 40.7%, p = 0.032). In bivariate analysis, a higher Hb/Cr ratio was inversely associated with PCCD (OR 0.50; 95% CI 0.27–0.94; p = 0.032), mainly driven by new-onset diastolic dysfunction. This association remained significant after multivariable adjustment for age, sex, cardiovascular risk factors, and type of hematological disorder (all p < 0.05). The Hb/Cr ratio demonstrated superior discriminative performance for PCCD (AUC 0.59) compared with hemoglobin (AUC 0.50) and creatinine (AUC 0.45) considered separately (both p < 0.05). Lower baseline Hb/Cr values are independently associated with early surrogate markers of anthracycline-related cardiotoxicity. Larger prospective studies are warranted to validate its prognostic value.