Work

Discharge neutrophily-to-lymphocyte ratio and its trajectory as predictors of 30-day outcomes in acute heart failure

Year: 2026

Type: article

Abstract: AIMS: To evaluate whether discharge neutrophil-to-lymphocyte ratio (NLR) and its in-hospital trajectory predict 30-day outcomes after acute decompensated heart failure (ADHF) hospitalization, and to compare discharge NLR with admission NLR and with serial NLR measurement. METHODS: Retrospective cohort of 6784 ADHF discharges (2007-17; median age 78 [interquartile range: 69-85] years; 48.8% women). Patients were classified by discharge NLR (<5 vs ≥5) and by NLR trajectory (low→low, low→high, high→low, high→high). Primary endpoints were 30-day all-cause readmission and 30-day all-cause mortality. Multivariable Cox models adjusted for age, sex, anaemia, chronic kidney disease, diabetes, ischaemic heart disease, atrial fibrillation, peripheral vascular disease, and COPD. Discrimination was assessed using areas under the curve (AUCs) from adjusted logistic models. RESULTS: High discharge NLR (≥5) was present in 2258/6784 (33.3%). Event rates were higher with high vs low discharge NLR for readmission (25.5% vs 19.7%, P < .001) and mortality (7.8% vs 2.8%, P < .001). High discharge NLR was independently associated with readmission (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.05-1.40, P = .007) and mortality (HR 1.92, 95% CI 1.46-2.53, P < .001). Trajectory further stratified risk: high→high had the greatest risk (readmission HR 1.42, 95% CI 1.25-1.62, P < .001; mortality HR 3.42, 95% CI 2.53-4.62, P < .001); low→high was also high-risk (readmission HR 1.46, 95% CI 1.20-1.77, P < .001; mortality HR 3.05, 95% CI 2.00-4.65, P < .001). High→low showed reduced but residual risk vs low→low (readmission HR 1.07, 95% CI .93-1.23, P = .321; mortality HR 1.52, 95% CI 1.06-2.16, P = .021). Discharge NLR outperformed admission NLR (mortality AUC 0.731 vs 0.705; readmission AUC 0.573 vs 0.564). Serial NLR added minimal discrimination beyond discharge NLR alone (mortality AUC 0.736 vs 0.734; readmission AUC 0.571 for both). CONCLUSIONS: 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.

Source: ESC Heart Failure

DOI: 10.1093/eschf/xvag059