Prognostic value of neutrophil‑ to‑lymphocyte ratio in predicting long-term mortality in patients with ischemic and nonischemic heart failure.

INTRODUCTION Previous studies have shown that an elevated neutrophil-to-lymphocyte ratio (NLR) was associated with a poorer long-term prognosis in patients with heart failure (HF). OBJECTIVES We aimed to study the predictive value of the NLR in patients with left ventricular ejection fraction of 35% or lower. The second objective was to establish whether the NLR has the same prognostic value in patients with ischemic and nonischemic HF. PATIENTS AND METHODS The study group consisted of a cohort of patients with HF (1387 men, 347 women; median age, 61 years) from the prospective COMMIT-HF registry. The primary endpoint was all-cause mortality. Patients were divided into tertiles based on the NLR values on admission. The first (low), second (medium), and third (high) tertiles were defined as NLR <= 2.04 (n = 578), NLR 2.05-3.1 (n = 578) and NLR > 3.1 (n = 578), respectively. RESULTS During long-term follow-up, 443 deaths were reported. The 12-month mortality in patients in the third NLR tertile was almost 3-fold higher compared with those in the first tertile (7.61% vs 20.07%; P < 0.001). In a multivariate analysis, the NLR was an independent factor of mortality (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.82-2.92; P < 0.0001). In addition, the multivariate analysis revealed that the third NLR tertile in the ischemic HF group was an independent factor related to long-term mortality (HR, 1.51; 95% CI, 1.11-2.04; P = 0.008). In the nonischemic HF group, the influence of the NLR on long-term survival was not confirmed. CONCLUSIONS The association between the NLR and the risk of death in long-term follow-up was confirmed only in the subgroup of patients with ischemic HF.