Association of admission neutrophil-to-lymphocyte ratio and neutrophil-and-monocyte-to-lymphocyte ratio with in-hospital mortality in acute heart failure: A secondary analysis of a cross-sectional study

BackgroundInflammation contributes to heart failure (HF) progression, and readily available inflammatory biomarkers may provide prognostic information. We evaluated the association and discriminatory performance of admission neutrophil-to-lymphocyte ratio (NLR) and neutrophil-and-monocyte-to-lymphocyte ratio (NMLR) for in-hospital mortality in acute HF.MethodsThis secondary analysis of a cross-sectional study included consecutive patients aged ≥14 years admitted with acute HF to Kilimanjaro Christian Medical Centre, Tanzania, between 1 May and 31 October 2024. Admission NLR and NMLR were calculated from routine hematological parameters and natural log-transformed for logistic regression because of skewed distributions. Univariable and multivariable binary logistic regression assessed associations with in-hospital mortality; variables with p<0.10 in univariable analysis were considered for multivariable inclusion. Receiver operating characteristic (ROC) analysis assessed discrimination and identified study-specific thresholds.ResultsAmong 290 patients, 228 (78.6%) were discharged and 62 (21.4%) died. Higher LN(NLR) was associated with mortality in univariable analysis (cOR: 1.47; 95% CI: 1.11-1.96; p=0.008) and remained independently associated after adjustment (aOR: 1.45; 95% CI: 1.04-2.01; p=0.028). Similarly, LN(NMLR) was associated with mortality (cOR: 1.47; 95% CI: 1.10-1.97; p=0.009) and remained independently associated after adjustment (aOR: 1.44; 95% CI: 1.03-2.02; p=0.032). NLR and NMLR demonstrated modest discrimination, with AUCs of 0.625 (95% CI: 0.544-0.705) and 0.624 (95% CI: 0.543-0.705), respectively. Thresholds were 5.35 for NLR and 6.47 for NMLR.ConclusionHigher admission NLR and NMLR were independently associated with in-hospital mortality and demonstrated modest discriminatory ability. These inexpensive biomarkers may complement clinical risk stratification, although the thresholds require external validation.