Admission NT-proBNP-to-Albumin Ratio, Systemic Immune-Inflammation Index, and Early Severe Clinical Deterioration in Acute Decompensated Heart Failure

Q: What are the key findings of this study?

Admission log10 NT-proBNP-to-albumin ratio and SII independently predicted severe in-hospital deterioration in ADHF.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute decompensated heart failure (ADHF) (n=1450). Intervention: Admission log10 NT-proBNP-to-albumin ratio and systemic immune-inflammation index (SII) vs. Patients without early severe clinical deterioration (lower biomarker levels). Primary outcome: Composite severe clinical course (intensive care unit admission, non-invasive ventilation, or endotracheal intubation during index hospitalization) (OR 1.988, 95% CI 1.498-2.640, p=<0.001).

Q: What does this research mean for the field?

Admission log10 NT-proBNP-to-albumin ratio and systemic immune-inflammation index are independently associated with early severe clinical deterioration in acute decompensated heart failure, though their standalone discriminatory capacity is modest. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between admission laboratory biomarkers, composite inflammatory indices, and early severe clinical deterioration in patients hospitalized with acute decompensated heart failure.

Mehmet Gökhan Kaya; Mehmet Kılınç

doi:10.21203/rs.3.rs-11425334/v1

November 6, 2026Open Access

Admission NT-proBNP-to-Albumin Ratio, Systemic Immune-Inflammation Index, and Early Severe Clinical Deterioration in Acute Decompensated Heart Failure

View Full Paper

Ask AI

Bookmark

Share

Key result

Higher log10 NT-proBNP-to-albumin ratio linked to ~99% higher risk of severe ADHF deterioration per unit.

OR 1.988
95% CI 1.498-2.640
P<0.001
n=1,450

Why the study?

Early risk stratification for patients presenting to the emergency department with acute decompensated heart failure (ADHF) remains challenging, motivating an evaluation of admission-based laboratory biomarkers and composite inflammatory indices to predict early severe clinical deterioration.

Do admission-based laboratory biomarkers and composite indices (such as the log10 NT-proBNP-to-albumin ratio and systemic immune-inflammation index) predict early severe clinical deterioration in adult patients hospitalized with acute decompensated heart failure?

Key Points

To evaluate the association between admission laboratory biomarkers, composite inflammatory indices, and early severe clinical deterioration in patients hospitalized with acute decompensated heart failure.
Conducted a retrospective single-center cohort study of 1,450 adult patients hospitalized with acute decompensated heart failure from the emergency department between January 2023 and January 2025.
Evaluated admission biomarkers and indices, including systemic immune-inflammation index (SII), C-reactive protein-to-albumin ratio (CAR), prognostic nutritional index (PNI), and log10 NT-proBNP-to-albumin ratio.
Defined the primary endpoint as a composite severe clinical course comprising intensive care unit admission, non-invasive ventilation, or endotracheal intubation during the index hospitalization.
A severe clinical course occurred in 338 of 1,450 patients (23.3%).
The log10 NT-proBNP-to-albumin ratio was independently associated with severe clinical course in Model 1 (OR 2.008, 95% CI 1.493–2.701, p < 0.001) and Model 2 (OR 1.988, 95% CI 1.498–2.640, p < 0.001), with an AUC of 0.608 (95% CI 0.570–0.646, p < 0.001).
Log2-transformed SII independently predicted severe outcomes in Model 2 (OR 1.179 per doubling, 95% CI 1.075–1.293, p < 0.001) with an AUC of 0.595 (95% CI 0.559–0.631, p < 0.001), reflecting statistically significant but modest standalone discrimination.

Study Design

Type

Cohort (n=1,450)

Multicenter

No

Structured PICO

Do admission-based laboratory biomarkers and composite indices (such as the log10 NT-proBNP-to-albumin ratio and systemic immune-inflammation index) predict early severe clinical deterioration in adult patients hospitalized with acute decompensated heart failure?

P

Population

1,450 adult patients (≥18 years) hospitalized from the emergency department with acute decompensated heart failure at a single center in Turkey between January 2023 and January 2025, followed during index hospitalization.

E

Exposure

Admission-based laboratory biomarkers and composite indices, specifically the log10 NT-proBNP-to-albumin ratio, systemic immune-inflammation index (SII), C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI), measured at emergency department admission prior to in-hospital treatment.

O

Outcome

Composite of early severe clinical deterioration (defined as intensive care unit admission, non-invasive ventilation [CPAP or BiPAP], or endotracheal intubation) during the index hospitalization.composite

Main Result

Odds Ratio: 1.988 (95% CI 1.498–2.64)

p-value: p=<0.001

In patients hospitalized with acute decompensated heart failure, admission log10 NT-proBNP-to-albumin ratio and systemic immune-inflammation index are independently associated with early severe clinical deterioration, but their modest discriminatory performance limits their utility to complementary rather than standalone risk assessment tools.

Limitations

Retrospective, single-center design limiting causal inference and generalizability
Indices calculated only at emergency department admission without evaluating dynamic biomarker changes during hospitalization
Lack of key clinical variables such as left ventricular ejection fraction, echocardiographic phenotype, hemodynamic parameters, treatment strategies, and major comorbidities (diabetes, hypertension, CKD)
Composite outcome comprised heterogeneous endpoints differing in clinical severity
Unavailable post-discharge mortality and readmission data, and restriction to hospitalized patients
Retrospective, single-center design limits causal inference and generalizability
Indices were calculated using only emergency department admission values without evaluating dynamic biomarker changes during hospitalization
Relevant clinical variables (LVEF, echocardiographic phenotype, hemodynamic parameters, treatment strategies, diuretic response, concomitant infections) and major comorbidities (diabetes mellitus, hypertension, CKD) were not collected
Information on heart failure etiology, previous heart failure diagnosis, and prior heart failure hospitalizations was unavailable
Composite outcome comprised heterogeneous endpoints, and post-discharge mortality and readmission data were unavailable

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May aid adjunctive ADHF risk stratification; leaves open whether ratios improve outcomes or require prospective validation.

Abstract

Background Early risk stratification in acute decompensated heart failure (ADHF) remains challenging in the emergency department. This study aimed to evaluate the association between admission-based laboratory biomarkers, composite inflammatory indices, and early severe clinical deterioration in patients hospitalized with ADHF. Methods This retrospective single-center cohort study included 1,450 adult patients hospitalized from the emergency department with ADHF between January 2023 and January 2025. Admission laboratory biomarkers and composite indices, including the systemic immune-inflammation index (SII), C-reactive protein-to-albumin ratio (CAR), prognostic nutritional index (PNI), and log10 NT-proBNP-to-albumin ratio, were evaluated. The primary outcome was a composite severe clinical course defined as intensive care unit admission, non-invasive ventilation (NIV), or endotracheal intubation during index hospitalization. Results Severe clinical course occurred in 338 patients (23.3%). In multivariable analysis, the log10 NT-proBNP-to-albumin ratio remained independently associated with severe clinical course in both tested models (Model 1: OR 2.008, 95% CI 1.493–2.701; Model 2: OR 1.988, 95% CI 1.498–2.640; both p < 0.001). In the extended model, SII was also independently associated with severe clinical course (OR 1.179 per doubling, 95% CI 1.075–1.293, p < 0.001). ROC curve analysis demonstrated statistically significant but limited discriminatory performance for both the log10 NT-proBNP-to-albumin ratio (AUC 0.608, 95% CI 0.570–0.646, p < 0.001) and SII (AUC 0.595, 95% CI 0.559–0.631, p < 0.001). Conclusion In patients hospitalized with ADHF, early severe clinical deterioration was associated with higher inflammatory, cardiorenal, and myocardial stress markers. The log10 NT-proBNP-to-albumin ratio showed the most consistent independent association, while SII provided an additional inflammatory risk signal. These routinely available admission-based indices may provide complementary information for early risk assessment but demonstrated only modest discriminatory performance.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Kaya et al. (2026) conducted a cohort in Acute decompensated heart failure (ADHF) (n=1,450). Admission log10 NT-proBNP-to-albumin ratio and systemic immune-inflammation index (SII) vs. Patients without early severe clinical deterioration (lower biomarker levels) was evaluated on Composite severe clinical course (intensive care unit admission, non-invasive ventilation, or endotracheal intubation during index hospitalization) (OR 1.988, 95% CI 1.498-2.640, p=<0.001). Admission log10 NT-proBNP-to-albumin ratio and SII independently predicted severe in-hospital deterioration in ADHF.

synapsesocial.com/papers/6aefbd5d50d2071ffda4bc8f https://doi.org/10.21203/rs.3.rs-11425334/v1

View Full Paper

Ask AI

Bookmark

Share

Admission NT-proBNP-to-Albumin Ratio, Systemic Immune-Inflammation Index, and Early Severe Clinical Deterioration in Acute Decompensated Heart Failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Admission NT-proBNP-to-Albumin Ratio, Systemic Immune-Inflammation Index, and Early Severe Clinical Deterioration in Acute Decompensated Heart Failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading