Preoperative inflammatory–nutritional vulnerability and early recovery burden after durable LVAD implantation: the Naples Prognostic Score

We examined whether the preoperative Naples Prognostic Score (NPS) is associated with early recovery after durable left ventricular assist device (LVAD) implantation while accounting for death before discharge. This retrospective single-center study included 354 patients who underwent implantation during 2015-2026 and had complete NPS measurements: NPS 0-2, n = 102; NPS 3-4, n = 252. The primary outcome was hospital length of stay (LOS) among patients discharged alive. Clinical models included INTERMACS profiles; echocardiographic and hemodynamic covariates were added separately and together. Competing-risk analyses included all patients, with death before discharge as the competing event. Sparse binary outcomes were analyzed using parsimonious Firth logistic regression. Among 301 patients discharged alive, hospital LOS was 18.0 days with high NPS versus 14.0 days with low/intermediate NPS (p = 0.008). The adjusted geometric-mean ratio was 1.15 (95% CI 1.01-1.30) in the clinical/INTERMACS model and 1.14 (0.99-1.31) in the combined model. In all 354 patients, the 30-day cumulative incidence of live discharge was 72.2% versus 84.3%; clinical and combined subdistribution hazard ratios were 0.77 (0.60-0.99) and 0.79 (0.61-1.03). There were 41 deaths within 30 days; the parsimonious adjusted odds ratio was 2.82 (1.19-8.03). Transfusion associations diminished after hemoglobin adjustment. High NPS was associated with longer hospitalization among patients discharged alive and a lower cumulative incidence of live discharge. After combined echocardiographic and hemodynamic adjustment, confidence intervals for hospital LOS and live discharge included the null. NPS may characterize preoperative illness associated with recovery burden; its incremental predictive value and role in treatment decisions require further study.