Admission NT-proBNP-to-Albumin Ratio, Systemic Immune-Inflammation Index, and Early Severe Clinical Deterioration in Acute Decompensated Heart Failure
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Early risk stratification in acute decompensated heart failure (ADHF) remains challenging in the emergency department. This study aimed to evaluate the association between admission-based laboratory biomarkers, composite inflammatory indices, and early severe clinical deterioration in patients hospitalized with ADHF. Methods This retrospective single-center cohort study included 1,450 adult patients hospitalized from the emergency department with ADHF between January 2023 and January 2025. Admission laboratory biomarkers and composite indices, including the systemic immune-inflammation index (SII), C-reactive protein-to-albumin ratio (CAR), prognostic nutritional index (PNI), and log10 NT-proBNP-to-albumin ratio, were evaluated. The primary outcome was a composite severe clinical course defined as intensive care unit admission, non-invasive ventilation (NIV), or endotracheal intubation during index hospitalization. Results Severe clinical course occurred in 338 patients (23.3%). In multivariable analysis, the log10 NT-proBNP-to-albumin ratio remained independently associated with severe clinical course in both tested models (Model 1: OR 2.008, 95% CI 1.493–2.701; Model 2: OR 1.988, 95% CI 1.498–2.640; both p < 0.001). In the extended model, SII was also independently associated with severe clinical course (OR 1.179 per doubling, 95% CI 1.075–1.293, p < 0.001). ROC curve analysis demonstrated statistically significant but limited discriminatory performance for both the log10 NT-proBNP-to-albumin ratio (AUC 0.608, 95% CI 0.570–0.646, p < 0.001) and SII (AUC 0.595, 95% CI 0.559–0.631, p < 0.001). Conclusion In patients hospitalized with ADHF, early severe clinical deterioration was associated with higher inflammatory, cardiorenal, and myocardial stress markers. The log10 NT-proBNP-to-albumin ratio showed the most consistent independent association, while SII provided an additional inflammatory risk signal. These routinely available admission-based indices may provide complementary information for early risk assessment but demonstrated only modest discriminatory performance.
Source: Research Square
Authors: Mehmet Gokhan Kaya, Mehmet Kilinc
Institution: Pamukkale University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225408453