Prognostic value of neutrophil‑to‑lymphocyte ratio in predicting long-term mortality in patients with ischemic and nonischemic heart failure

INTRODUCTION    Previous studies have shown that an elevated neutrophil-to-lymphocyte ratio (NLR) was associated with a poorer long-term prognosis in patients with heart failure (HF).
OBJECTIVES    We aimed to study the predictive value of the NLR in patients with left ventricular ejection fraction of 35% or lower. The second objective was to establish whether the NLR has the same prognostic value in patients with ischemic and nonischemic HF.
PATIENTS AND METHODS    The study group consisted of a cohort of patients with HF (1387 men, 347 women; median age, 61 years) from the prospective COMMIT-HF registry. The primary endpoint was all-cause mortality. Patients were divided into tertiles based on the NLR values on admission. The first (low), second (medium), and third (high) tertiles were defined as NLR ≤2.04 (n = 578), NLR 2.05–3.1 (n = 578) and NLR >3.1 (n = 578), respectively.
RESULTS    During long-term follow-up, 443 deaths were reported. The 12-month mortality in patients in the third NLR tertile was almost 3-fold higher compared with those in the first tertile (7.61% vs 20.07%; P <0.001). In a multivariate analysis, the NLR was an independent factor of mortality (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.82–2.92; P <0.0001). In addition, the multivariate analysis revealed that the third NLR tertile in the ischemic HF group was an independent factor related to longterm mortality (HR, 1.51; 95% CI, 1.11–2.04; P = 0.008). In the nonischemic HF group, the influence of the NLR on long-term survival was not confirmed.
CONCLUSIONS    The association between the NLR and the risk of death in long-term follow-up was confirmed only in the subgroup of patients with ischemic HF.