Predictive role of nutritional and immune-inflammatory indexes in the diagnostic work-up and risk stratification of heart failure with preserved ejection fraction

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a significant public health concern with high morbidity. This study evaluates the prognostic significance of Prognostic Nutritional Index (PNI) and Pan-Immune-Inflammation Value (PIV) in HFpEF, aiming to enhance understanding of its inflammatory and nutritional aspects and identify markers for better diagnosis and risk stratification. METHODS: This retrospective cohort study included 71 patients diagnosed with HFpEF using the HFA-PEFF algorithm and 81 control subjects without heart failure. The PIV, and PNI indices were calculated. A 6-month follow-up of the HFpEF group was conducted to assess rehospitalization rates. RESULTS: The study found that patients with HFpEF had significantly higher PIV and PNI rates than the control group (P=0.016, P<0.001). A negative correlation (r=-0.328, P<0.001) was observed between the PNI and HFA-PEFF scores. The ROC analysis demonstrated that PIV (AUC: 0.92) had the strongest predictive ability for rehospitalization, followed by Systemic Immune-Inflammatory Index (SII, AUC: 0.87) and PNI (AUC: 0.78), while BMI showed the weakest performance (AUC: 0.59). The multivariate logistic regression analysis demonstrated that both PNI (OR: 0.783, 95% CI: 0.627-0.977, P=0.031) and PIV (OR: 1.012, 95% CI: 1.003-1.021, P=0.008) were significant predictors of rehospitalization in HFpEF patients. CONCLUSIONS: PIV and PNI are important parameters that play a predictive role in diagnosing HFpEF and independently predicting rehospitalization. In the multivariate analyses for rehospitalization, that PIV stands out more than SII, and PNI stands out more than BMI, was current and valuable information.