Key result
Higher SIRI linked to ~32% higher 1-year adverse CV risk per SD in HFrEF.
Why the study?
The prognostic value and comparative performance of systemic inflammatory biomarkers in hospitalized patients with HFrEF for predicting 1-year adverse cardiovascular outcomes were unclear.
Do elevated systemic inflammatory indices (SIRI, SII, NLR, MLR) predict 1-year adverse cardiovascular outcomes in hospitalized patients with HFrEF?
Cohort (n=1,814)
Yes
Do elevated systemic inflammatory indices (SIRI, SII, NLR, MLR) predict 1-year adverse cardiovascular outcomes in hospitalized patients with HFrEF?
Hazard Ratio: 1.325 (95% CI 1.27–1.38)
p-value: p=<0.001
Higher levels of accessible complete blood count-derived inflammatory indices (SIRI, SII, NLR, MLR) are significantly associated with increased 1-year cardiovascular risk in hospitalized patients with HFrEF, with SIRI showing the strongest discriminative performance.
SIRI may aid prognostication in hospitalized HFrEF; leaves open incremental value and need for prospective validation before clinical adoption.
Objective: This study sought to examine the associations between four inflammatory biomarkers and 1-year adverse cardiovascular outcomes among hospitalized patients with heart failure with reduced ejection fraction (HFrEF) and to compare their prognostic performance. Methods: A multicenter retrospective cohort study was conducted involving 1814 hospitalized patients with HFrEF (LVEF <40%). Four inflammation-derived biomarkers were derived from standard blood test results. The relationships between these biomarkers and the 1-year incidence of adverse cardiovascular outcomes were analyzed using Cox proportional hazards regression and restricted cubic spline (RCS) modeling. Event-free survival across biomarker tertiles was compared via Kaplan-Meier survival analysis. The discriminative ability of each biomarker was assessed through receiver operating characteristic (ROC) curves, time-dependent ROC analyses, and C-statistics. Additional sensitivity analyses were performed to verify the stability and reliability of the results. Results: Elevated levels of all four biomarkers were significantly associated with an increased risk of adverse cardiovascular outcomes in patients with HFrEF. Each 1-SD increase in systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) was associated with a 32.5%, 46.1%, 54.0%, and 98.3% higher hazard of adverse cardiovascular outcomes, respectively. Tertile analyses showed that the increased risk of adverse cardiovascular outcomes was mainly observed in the highest biomarker tertiles. Among the four markers, SIRI showed better discriminative performance than the other indices in this cohort, with an AUC of 0.705, which was supported by time-dependent ROC and C-statistic analyses. Conclusion: Higher SIRI, SII, NLR, and MLR levels were associated with an increased risk of adverse cardiovascular outcomes in patients with HFrEF. SIRI showed numerically better discrimination among hospitalized patients with HFrEF in this cohort, but further external validation is required before clinical application.
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Qiu et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=1,814). Systemic inflammation response index (SIRI) per 1-SD increase vs. Lower inflammatory index levels was evaluated on 1-year adverse cardiovascular outcomes (composite of HF rehospitalization and cardiovascular death) (HR 1.325, 95% CI 1.270-1.380, p=<0.001). Each 1-SD increase in the systemic inflammation response index (SIRI) was significantly associated with a 32.5% higher hazard of 1-year adverse cardiovascular outcomes in patients with HFrEF (HR 1.325).
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