Key result
In elderly patients with HFpEF, the advanced lung cancer inflammation index (ALI) was significantly associated with all-cause death (HR for log-transformed ALI 0.50; 95% CI 0.34-0.75; P=0.001).
Why the study?
Malnutrition and inflammation predict poor HF outcomes, but the prognostic value of the advanced lung cancer inflammation index had not been investigated in elderly multimorbid HFpEF patients.
Does the advanced lung cancer inflammation index (ALI) predict all-cause death in elderly multimorbid patients with HFpEF?
Observational (n=1,238)
Yes
Does the advanced lung cancer inflammation index (ALI) predict all-cause death in elderly multimorbid patients with HFpEF?
Hazard Ratio: 0.5 (95% CI 0.34–0.75)
p-value: p=0.001
Low advanced lung cancer inflammation index (ALI) levels are significantly associated with poor prognosis and all-cause death in elderly multimorbid patients with HFpEF, complementing existing risk indices.
ALI may aid prognosis in elderly HFpEF; hypothesis-generating and requires prospective validation before clinical use.
AIMS: Malnutrition and inflammation are associated with poor outcomes with heart failure (HF). As a marker integrating inflammation and nutritional status, the advanced lung cancer inflammation index (ALI), calculated by body mass index × serum albumin level / neutrophil-to-lymphocyte ratio, has been developed for the prognosis of several diseases including HF. The aim of this study is to investigate the prognostic value of ALI in elderly multimorbid HF patients with HF with preserved ejection fraction (HFpEF). METHODS: The study utilized data from the Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction (PURSUIT-HFpEF). Patients with acute decompensated HF and left ventricular ejection fraction ≥50% were included. ALI levels were calculated from discharge data. The primary endpoint was all-cause death. RESULTS: A total of 1238 patients [83 (77, 87) years, 555 (45%) male] were enrolled, with 1121 analysed for prognostic value of ALI. In the multivariable Cox model, ALI was significantly associated with the primary endpoint [adjusted hazard ratio (HR) for log-transformed ALI: 0.50, 95% confidence interval (CI): 0.34-0.75, P = 0.001]. ALI appears to enhance the prognostic value of the MAGGIC risk score [net reclassification improvement (NRI) = 46% (95% CI: 28%-65%), P < 0.001; integrated discrimination improvement (IDI) = 4.6% (95% CI: 2.8%-6.5%), P < 0.001], the geriatric nutritional risk index [NRI = 16% (95% CI: -3% to 35%), P = 0.103; IDI = 2.0% (95% CI: 0.8%-3.1%), P < 0.001] and C-reactive protein [NRI = 39% (95% CI: 20%-58%), P < 0.001; IDI = 4.8% (95% CI: 2.9%-6.6%), P < 0.001]. CONCLUSIONS: Low ALI levels were significantly associated with poor prognosis in elderly multimorbid HFpEF patients. ALI might complement existing risk indices for prognostic assessment.
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Sakamoto et al. (2025) conducted an observational in Heart Failure with Preserved Ejection Fraction (HFpEF) (n=1,238). Advanced lung cancer inflammation index (ALI) was evaluated on All-cause death (HR 0.50, 95% CI 0.34-0.75, p=0.001). In elderly patients with HFpEF, the advanced lung cancer inflammation index (ALI) was significantly associated with all-cause death (HR for log-transformed ALI 0.50; 95% CI 0.34-0.75; P=0.001).
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