Correlation analysis between the static and the changed neutrophil-to-lymphocyte ratio and in-hospital mortality in critical patients with acute heart failure

ABSTRACT

Objective

Association between neutrophil-to-lymphocyte ratio (NLR) on admission and poor prognosis in patients with acute heart failure (AHF) has been well established. However, the relationship between dynamic changes in NLR and in-hospital mortality in AHF patients has not been studied. Our purpose was to determine if an early change in NLR within the first week after AHF patients was admitted to intensive care unit (ICU) was associated with in-hospital mortality.

Methods

Data from the medical information mart for intensive care IV (the MIMIC-IV) database was analyzed. The effect of baseline NLR on in-hospital mortality in critical patients with AHF was evaluated utilizing smooth curve fitting and multivariable logistic regression analysis. Moreover, comparison of the dynamic change in NLR among survivors and non-survivors was performed using the generalized additive mixed model (GAMM).

Results

There were 1169 participants who took part in the present study, 986 of whom were in-hospital survivors and 183 of whom were in-hospital non-survivors. The smooth curve fitting revealed a positive relationship between baseline NLR and in-hospital mortality, and multivariable logistic regression analysis indicated that baseline NLR was an independent risk factor for in-hospital mortality (OR 1.04, 95% CI 1.02,1.07, P-value = 0.001). After adjusting for confounders, GAMM showed that the difference in NLR between survivors and non-survivors grew gradually during the first week after ICU admission, and the difference grew by an average of 0.51 per day (β = 0.51, 95% CI 0.45–0.56, P-value <0.001).

Conclusions

Baseline NLR was associated with poor prognosis in critical patients with AHF. Early rises in NLR were linked to higher in-hospital mortality, which suggests that keeping track of how NLR early changes might help identify short-term prognosis of critical patients with AHF.

KEYWORDS:

• Acute heart failure
• neutrophil-to-lymphocyte ratio
• in-hospital mortality
• change
• intensive care unit

Declaration of financial/other relationships

No potential conflict of interest was reported by the author.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium from PGM for their review work but have no other relevant financial relationships to disclose.

Data availability statement

The data for this study come from https://mimic.mit.edu/. The data supporting the findings of the present paper could be provided by contacting the author, without reservation.

Ethics statement

Data of the present study was from the MIMIC-IV database. The MIMIC IV database was approved to build by the Institutional Review Boards of Beth Israel Deaconess Medical Center (Boston, MA) and the Massachusetts Institute of Technology (Cambridge, MA). Data for the present study was extracted by one author, Tao Liu, who has completed the online training course and passed the exam (ID: 9,008,147).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2022.2129177

Additional information

Funding

This work was supported by the Shanghai Jinshan District Health Commission Project Fund (grant number: JSKJ-KTMS-2019-21, grant number: JSKJ-KTMS-2020-09), the Shanghai Jinshan District Medical and Health Science and Technology Innovation Fund Project (grant number: 2020-3-30), and the Shanghai Sixth People’s Hospital Medical Group Scientific Research Fund Project (grant number: 2019-02).