Heart failure & cardiomyopathies
Neutrophil-to-Lymphocyte Ratio: Link to Congestion, Inflammation, and Mortality in Outpatients with Heart Failure
Authors' conclusion
Low lymphocyte count is associated with more congestion and high neutrophil count with more inflammation, which may explain why a greater NLR is associated with a poorer prognosis. For patients with heart failure, NLR or its components could be useful for risk stratification or for monitoring evolving risk, but might also be therapeutic targets.
Study context
- Population
- Ambulatory patients with heart failure (HF) and either left ventricular systolic dysfunction or high NTproBNP (≥125 ng/L)813 with detailed echocardiographic assessment
- Participants
- 4,702 patients
- Exposure
- Highest vs lowest quartile of neutrophil-to-lymphocyte ratio (NLR); NLR and its components and mortality
- Outcome
- Clinical characteristics, highest vs lowest NLR quartile
Main finding
As reported in the abstract
- Highest quartile older, higher NTproBNP, more likely HFrEF, atrial fibrillation and loop diuretics
Observational data: associations, not effects.
Further findings
Mortality
| HR (95% CI) | P value | ||
|---|---|---|---|
| Higher NLRHigher mortality · adjusted for NTproBNP and HsCRP | 1.05 (1.03–1.06) | P < 0.001 | |
| Neutrophil countHigher mortality · adjusted for NTproBNP and HsCRP | 1.07 (1.04–1.10) | P < 0.001 | |
| Higher lymphocyte countLower risk · adjusted for NTproBNP and HsCRP | 0.88 (0.82–0.95) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
- Mortality: all P < 0.001
Correlations with NTproBNP, congestion and high-sensitivity C-reactive protein (hsCRP)
- Lymphocyte count vs NTproBNP
- r = −0.31
- Lymphocyte count vs left atrial volume index
- r = −0.25
- Lymphocyte count vs inferior vena cava diameter
- r = −0.24
- Neutrophil count vs hsCRP
- r = 0.31, P < 0.001
- 813 patients with detailed echocardiographic assessment
Death · median follow-up 54 (29-100) months
- Patients died
- 3015 (64%)
Original publication
Neutrophil-to-Lymphocyte Ratio: Link to Congestion, Inflammation, and Mortality in Outpatients with Heart Failure. ESC Heart Fail. Published 2 March 2025. doi:10.
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