Why the study?
Although several routinely available systemic inflammatory biomarkers have been associated with adverse outcomes in acute cardiovascular diseases, their long-term prognostic value and external validity in cardiac intensive care unit populations remained incompletely defined.
Do systemic inflammation biomarkers (NLR, PLR, SII, CAR, FARI, and IPF) measured at admission predict long-term all-cause mortality in critically ill cardiac patients admitted to the CCU?
Cohort (n=2,131)
No
Do systemic inflammation biomarkers (NLR, PLR, SII, CAR, FARI, and IPF) measured at admission predict long-term all-cause mortality in critically ill cardiac patients admitted to the CCU?
Routine inflammatory indices measured at CCU admission—specifically NLR, SII, CAR, and FARI—independently predict long-term mortality and can serve as simple tools for early risk stratification in critically ill cardiac patients.
Background Systemic inflammation plays a central role in acute cardiovascular diseases. Several routinely available inflammatory biomarkers – including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), C-reactive protein-to-albumin ratio (CAR), fibrinogen-to-albumin ratio index (FARI), and immature platelet fraction (IPF) – have been associated with adverse outcomes. However, their long-term prognostic value and external validity in cardiac intensive care unit (CCU) populations remain incompletely defined. Methods We conducted a single-center observational cohort study including consecutive patients admitted to the CCU between January 2020 and December 2021. Optimal admission cutoff values for NLR, PLR, SII, CAR, FARI, and IPF were determined using survival-based analyses including long-term all-cause mortality. External validation was performed using the predetermined cut-off values in an independent CCU patients cohort , for Kaplan–Meier survival analyses. Multivariable Cox proportional hazards models, adjusted for pertinent variables, were used to assess independent predictors of mortality. Results The study included 2131patients for biomarker survival cut-off analyses, with ~1,100 patients in the external validation cohort. Patients with above-threshold biomarker values had higher long-term mortality for NLR, SII, CAR, and FARI (log-rank p<0.01). Multivariable Cox proportional-hazards regression models reveal that above-threshold NLR (HR 1.69, 95% CI 1.24–2.29), SII (HR 1.40, 95% CI 1.02–1.92), CAR (HR 1.94, 95% CI 1.43–2.65), and FARI (HR 1.72, 95% CI 1.25–2.38) remained independently associated with long-term mortality. In contrast, PLR and IPF did not retain independent prognostic significance. The proportional-hazards regression models also revealed that higher counts of above-threshold biomarkers were associated with increased long-term mortality. Conclusions Among routinely available inflammatory biomarkers measured at CCU admission, NLR, SII, CAR, and FARI predicted long-term mortality as validated using an independent external cohort, whereas PLR and IPF were now shown to offer incremental value beyond established clinical risk factors. Different biomarker combinations improved long-term mortality prediction. These findings support the use of selected inflammatory indices as simple tools for early risk stratification in critically ill cardiac patients.
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Qadan et al. (2026) conducted a cohort in Critically ill cardiac conditions requiring cardiac intensive care unit (CCU) admission (n=2,131). Elevated systemic inflammatory biomarkers at CCU admission (NLR, PLR, SII, CAR, FARI, IPF) vs. Below-threshold admission biomarker values was evaluated on Long-term all-cause mortality (HR 1.94, 95% CI 1.43-2.65, p=<0.01).
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