Heart failure & cardiomyopathiesCohort study
Discharge neutrophily-to-lymphocyte ratio and its trajectory as predictors of 30-day outcomes in acute heart failure
- Retrospective cohort
Authors' conclusion
Discharge NLR is an independently prognostic, routinely available biomarker for 30-day readmission and mortality after ADHF. Persistently elevated or rising NLR identifies patients at the highest short-term risk, while normalization attenuates but does not eliminate risk. A single discharge measurement performs comparably to serial assessment, supporting practical integration of discharge NLR into risk-stratified follow-up, including in resource-limited settings.
Study context
- Population
- Acute decompensated heart failure (ADHF) discharges, 2007–17
- Participants
- 6,784 ADHF discharges
- Exposure
- discharge neutrophil-to-lymphocyte ratio (NLR) and NLR trajectory
- High discharge NLRn = 2,258
- Outcome
- 30-day all-cause readmission and 30-day all-cause mortality
- Follow-up
- 30-day
Main finding
As reported in the abstract
High discharge NLR
25.5%
readmission · mortality 7.8%
Low discharge NLR
19.7%
readmission · mortality 2.8%
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| 30-day readmission and mortality by NLR trajectory — high→high vs low→low · readmission | 1.42 (1.25–1.62) | P < 0.001 | |
| 30-day readmission and mortality by NLR trajectory — high→high vs low→low · mortality | 3.42 (2.53–4.62) | P < 0.001 | |
| 30-day readmission and mortality by NLR trajectory — low→high vs low→low · readmission | 1.46 (1.20–1.77) | P < 0.001 | |
| 30-day readmission and mortality by NLR trajectory — low→high vs low→low · mortality | 3.05 (2.00–4.65) | P < 0.001 | |
| 30-day readmission and mortality by NLR trajectory — high→low vs low→low · mortality | 1.52 (1.06–2.16) | P = 0.021 | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | HR (95% CI) | P value |
|---|---|---|
| 30-day readmission and mortality by NLR trajectory — high→low vs low→low · readmission | 1.07 (.93-1.23) | P = 0.321 |
Discrimination: discharge NLR vs admission NLR
- mortality AUC, discharge vs admission
- 0.731 vs 0.705
- readmission AUC, discharge vs admission
- 0.573 vs 0.564
- AUCs from adjusted logistic models
Discrimination: serial NLR vs discharge NLR alone
- mortality AUC, serial vs discharge
- 0.736 vs 0.734
- readmission AUC, for both
- 0.571
Original publication
Summarised from the published abstract; every number is checked against it